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Effects of pediatric chronic kidney disease and its etiology on tissue sodium concentration: a pilot study

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Abstract

Background

Sodium-23 magnetic resonance imaging (23Na MRI) allows non-invasive assessment of tissue sodium concentration ([Na+]). Age and chronic kidney disease (CKD) are associated with increased tissue [Na+] in adults, but limited information is available pertaining to children and adolescents. We hypothesized that pediatric CKD is associated with altered tissue [Na+] compared to healthy controls.

Methods

This was a case–control exploratory study on healthy children and adults and pediatric CKD patients. Study participants underwent an investigational visit, blood/urine biochemistry, and leg 23Na MRI for tissue [Na+] quantification (whole leg, skin, soleus muscle). CKD was stratified by etiology and patients’ tissue [Na+] was compared against healthy controls by computing individual Z-scores. An absolute Z-score > 1.96 was deemed to deviate significantly from the mean of healthy controls. Pearson correlation was used to compute the associations between tissue [Na+] and kidney function.

Results

A total of 36 pediatric participants (17 healthy, 19 CKD) and 19 healthy adults completed the study. Healthy adults had significantly higher tissue [Na+] compared with pediatric groups; conversely, no significant differences were found between healthy children/adolescents and CKD patients. Four patients with glomerular disease and one kidney transplant recipient due to atypical hemolytic-uremic syndrome had elevated whole-leg [Na+] Z-scores. Reduced whole-leg [Na+] Z-scores were found in two patients with tubular disorders (Fanconi syndrome, proximal–distal renal tubular acidosis). All tissue [Na+] measures were significantly associated with proteinuria and hypoalbuminemia.

Conclusions

Depending on etiology, pediatric CKD was associated with either increased (glomerular disease) or reduced (tubular disorders) tissue [Na+] compared with healthy controls.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information.

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Acknowledgements

The authors would like to thank the patients and caregivers for allowing us to share their results in the peer-reviewed literature. The authors would like to thank Ms. Tanya Tamasi and Mr. Justin Dorie for their support in this study.

Funding

This study was funded by the Can-SOLVE CKD Network and the Canadian Institutes of Health Research Strategy for Patient-Oriented Research.

Author information

Authors and Affiliations

  1. Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Fabio R. Salerno, Timothy J. Scholl & Christopher W. McIntyre

  2. The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada

    Fabio R. Salerno, Alireza Akbari, Sandrine Lemoine, Christopher W. McIntyre & Guido Filler

  3. Robarts Research Institute, Western University, London, ON, Canada

    Alireza Akbari & Timothy J. Scholl

  4. Claude Bernard Lyon 1 University, Lyon, France

    Sandrine Lemoine

  5. Ontario Institute for Cancer Research, Toronto, ON, Canada

    Timothy J. Scholl

  6. Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Christopher W. McIntyre & Guido Filler

  7. Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Guido Filler

  8. Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Guido Filler

Authors
  1. Fabio R. Salerno
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  2. Alireza Akbari
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  4. Timothy J. Scholl
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  5. Christopher W. McIntyre
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  6. Guido Filler
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Contributions

FRS finalized the study database, analyzed the images and data, and drafted the manuscript. AA developed and implemented the 23Na MRI acquisition and reconstruction technique, produced the concentration maps, and mentored the image analysis process. SL provided intellectual insight to the study conduct and data interpretation. TJS provided mentoring and technical insight for the 23Na MRI development and image acquisition. CWM conceived the original study idea and provided funding, intellectual insight, and supervision. GF was responsible for the investigational visits; facilitated recruitment; and provided clinical support, medical supervision, and intellectual insight on result interpretation. All authors contributed to and approved the final manuscript.

Corresponding author

Correspondence to Fabio R. Salerno.

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Salerno, F.R., Akbari, A., Lemoine, S. et al. Effects of pediatric chronic kidney disease and its etiology on tissue sodium concentration: a pilot study. Pediatr Nephrol 38, 499–507 (2023). https://doi.org/10.1007/s00467-022-05600-7

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  • DOI: https://doi.org/10.1007/s00467-022-05600-7

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