Effects of total parenteral nutrition on renal function in preterm neonate

Sum mary Aim: The aim of this study was to establish serum sistatine C, urine β2 microglobulin, gluthatione-S -transferase π and N-acetyle β-D glucosaminidase levels in order to evaluate the effect of total parenteral nutrition on renal function in premature infants. In addition, we aimed to compare the renal functions between premature infants receiving total parenteral nutrition and control groups receiving enteral feeding. Material and Method: A hundred four premature infants with a gestational age between 28 and 34 weeks were included in the study. The parenteral nutrition group consisted of 50 infants (male/female; 23/27 and mean weight 1258±212.3 g) and the enteral nutrition group consisted of 54 infants (male/female; 20/34 and mean weight 1608±206.1 g). In the parenteral nutrition group; total parenteral group nutrition was initiated on the 3rd day in the enteral nutrition group, minimal enteral nutrition was started on a mean of 6.3±2.4 days and total enteral nutrition was started on a mean of 24.5±6.3 days. Breastmilk was given orally or by orogastric/nasogastric tube at first day of life in the enteral group. On the 3rd and 30th day of life, blood samples of all patients were obtained for evaluating biochemical parameters and cystatin C and urine samples were obtained for evaluation of N-acetyl β-D glucosaminidase, gluthatione-S-transferase π, β2 microglobulin, sodium, creatinin levels, density and pH of the urine. The study was approved by the ethics commite (2008/16). Results: When we compared the patients who received total parenteral nutrition and enteral nutrition on the 3rd and 30th days, serum cystatin C, urinary β2 microglobulin, gluthatione-S-transferase π and N-acetylβ-D glucosaminidase excretions were similar on the 3rd day however were significantly higher on the 30th day in samples of the patients receiving total parenteral nutrition (p<0.05 for each parameter on each day). Conclusions: This study shows that total parenteral nutrition in premature infants can have adverse effects on glomerular and tubular functions of the kidney which can be manifested at an early time with cystatin C, β2 microglobulin, gluthatione-S-transferase π and N-acetyl β-D glucosaminidase. (Turk Arch Ped 2012; 47: 244-249)