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Salt and the newborn kidney

  • Practical Pediatric Nephrology
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Abstract

Renal function differs in term infants from that in adults, with lower glomerular filtration rate (GFR) and reduced proximal tubular reabsorption of sodium (Na) and water: nevertheless, it is adequate for their needs. This is not true of very preterm infants in whom hyponatraemia is common. Animal studies have shown that Na+, K+-ATPase and the Na+/K+ exchanger are poorly expressed at birth with rapid postnatal rises. Cell receptors for hormones that influence tubular Na transport are less numerous in the premature infant than later in life: intracellular second messenger systems may also be immature. The low GFR is due to vasoconstriction and may be necessary to prevent water and electrolyte wasting due to tubular overload. The hyponatraemia of prematurity could, in principle, be due either to Na loss or water excess and can be prevented either by giving additional Na or by restricting water intake. Na supplementation causes relative volume expansion (VE), water restriction volume contraction (VC); this is demonstrated by the effect of the two approaches on weight gain and on the levels of vasoactive hormones in the blood. We argue that moderate VE is more physiological than VC, both in attempting to simulate intrauterine conditions and in consideration of the infant's nutritional needs. The much less common complication of hypernatraemia is usually due to abnormal water loss and should be prevented by increasing water intake appropriately. The above applies to well, preterm babies: sick preterm infants are much more variable in their Na and water requirements than well infants of comparable gestation and weight and each needs an individually tailored regimen based on frequent clinical assessment and laboratory measurement.

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References

  1. Skou JC (1988) Overview: the Na, K-pump. In: Fleisher S, Fleischer B (eds) Methods in enzymology, vol. 156. Academic Press, New York, pp 1–25

    Google Scholar 

  2. Doucet A (1988) Function and control of Na+, K+-ATPase in single nephron segments of the mammalian kidney. Kidney Int 34: 749–760

    Google Scholar 

  3. Katz AI (1982) Renal Na+,K+-ATPase: its role in tubular sodium and potassium transport. Am J Physiol 242: F207-F219

    Google Scholar 

  4. Harris RC, Seifter JL, Lechene C (1986) Coupling of Na+−H+ exchange and Na+−K+ pump activity in cultured rat proximal tubule cells. Am J Physioll 251:C815-C824

    Google Scholar 

  5. Larsson SH, Rane S, Fukuda Y, Aperia A, Lechene C (1990) Changes in Na influx precede postnatal increase in Na+,K+-ATPase activity in rat renal proximal tubular cells. Acta Physiol Scand 138: 99–100

    Google Scholar 

  6. Rane S, Aperia A (1985) Ontogeny of Na+, K+-ATPase activity in thick ascending limb and of concentrating capacity. Am J Physiol 249:F723-F728

    Google Scholar 

  7. Schmidt U, Horster M (1977) Na−K-activated ATPase: activity maturation in rabbit nephron segments dissected in vitro. Am J Physiol 233:F55-F60

    Google Scholar 

  8. Baum M (1990) Neonatal rabbit juxtamedullary proximal convoluted tubule acidification. J Clin Invest 85: 499–506

    Google Scholar 

  9. Aperia A, Larsson L (1979) Correlation between fluid reabsorption and proximal tubule ultrastructure during development of the rat kidney. Acta Physiol Scand 105: 11–12

    Google Scholar 

  10. Aperia A, Larsson L (1984) Induced development of proximal tubular Na+,K+-ATPase, basolateral cell membranes and fluid reabsorption. Acta Physiol Scand 121: 133–141

    Google Scholar 

  11. Schwartz GJ, Evan AP (1984) Development of solute transport in rabbit proximal tubule. III. Na+, K+-ATPase activity. Am J Physiol 246: F845-F852

    Google Scholar 

  12. Celsi G, Nishi A, Akusjärvi G, Aperia A (1990) The abundance of Na+,K+-ATPase mRNA is regulated by glucocorticoid hormones in the infant rat kidney. Am J Physiol (in press)

  13. Orlowski J, Lingrel JB (1988) Tissue-specific and developmental regulation of rat Na+, K+-ATPase catalytic alpha isoform and beta subunit mRNAs. J Biol Chem 263: 10436–10442

    Google Scholar 

  14. Al Dahhan J, Stimmler L, Chantler C, Haycock GB (1987) The effect of antenatal dexamethasone on glomerular filtration rate and renal sodium excretion in premature infants. Pediatr Nephrol 1: 131–135

    Google Scholar 

  15. Fukuda Y, Bertorelli A, Aperia A (1990) Ontogeny of the regulation of Na+, K+-ATPase activity in the renal proximal tubule cell. Pediatr Res (in press)

  16. Kinoshita S, Jose PA, Felder RA (1989) Ontogeny of the dopamine 1 (DA1) receptor in rat renal convoluted tubule (abstract) Pediatr Res 25: 68A

    Google Scholar 

  17. Sposi NM, Bottero L, Cossu G, Russo G, Teta U, Peschle C (1989) Expression of protein kinase C genes during ontogenic development of the central nervous system. Mol Cell Biol 9: 2284–2288

    Google Scholar 

  18. Aperia A, Broberger O, Herin P, Zetterström R (1979) Sodium excretion in relation to sodium intake and aldosterone excretion in newborn preterm and fullterm infants. Acta Paediatr Scand 68: 813–817

    Google Scholar 

  19. Stephenson G, Hammet M, Hadaway G, Funder JW (1984) Ontogeny of renal mineralocorticoid receptors and urinary electrolyte responses in the rat. Am J Physiol 247: F665-F671

    Google Scholar 

  20. Aperia A, Herin P (1975) Development of glomerular perfusion rate and filtration rate in rats 17–60 days old. Am J Physiol 228: 1319–1325

    Google Scholar 

  21. Gruskin AB, Edelmann CM Jr, Yuan S (1970) Maturational changes in renal blood flow in piglets. Pediatr Res 4: 7–13

    Google Scholar 

  22. Yared A, Kon V, Ichikawa I (1984) Functional development of the kidney. In: Tune MB, Mendoza SA, Brenner BM, Stein JH (eds) Pediatric Nephrology. Churchill Livingstone, New York, pp 61–84

    Google Scholar 

  23. Al-Dahhan J, Haycock GB, Chantler C, Stimmler L (1983) Sodium homeostasis in term and preterm neonates. II. Gastrointestinal aspccts. Arch Dis Child 58: 343–345

    Google Scholar 

  24. Al-Dahhan J, Haycock GB, Chantler C, Stimmler L (1983) Sodium homcostasis in term and preterm neonates. I. Renal aspects. Arch Dis Child 58: 335–342

    Google Scholar 

  25. Day GM, Radde IC, Balfe JW, Chance GW (1976) Electrolyte abnormalities in very low birthweight infants. Pediatr Res 10: 522–526

    Google Scholar 

  26. Roy RN, Chance GW, Radde IC, Hill DE, Willis DM, Sheepers J (1976) Late hyponatraemia in very low birthweight infants. Prediatr Res 10: 526–531

    Google Scholar 

  27. Engelke SC, Shah BL, Vasan U, Raye JR (1978) Sodium balance in very low-birth-weight infants. J Pediatr 93: 837–841

    Google Scholar 

  28. Thodenius K (1974) Renal control of sodium homeostasis in infancy. Acta Paediatr Scand [Suppl.] 253: 1–28

    Google Scholar 

  29. Aperia A, Broberger O, Thodenius K, Zetterström R (1975) Renal control of sodium and fluid balance in newborn infants during intravenous maintenance therapy. Acta Paediatr Scand 64: 725–731

    Google Scholar 

  30. Siegel SR, Oh W (1976) Renal function as a marker of human fetal maturation. Acta Paediatr Scand 65: 481–485

    Google Scholar 

  31. Sulyok E, Varga F, Györy E, Jobst K, Csaba IF (1979) Postnatal development of renal sodium handling in premature infants. J Pediatr 95: 787–792

    Google Scholar 

  32. Sulyok E, Németh M, Tényi I, Csaba IF, Varga L, Varga F (1981) Relationship between the postnatal development of the renin-angiotensin-aldosterone system and the electrolyte and acid-base status in the sodium chloride supplemented premature infant. Acta Paediatr Acad Sci Hung 22: 109–121

    Google Scholar 

  33. Al-Dahhan J, Haycock GB, Nichol B, Chantler C, Stimmler L (1984) Sodium homeostasis in term and preterm neonates. III. Effect of salt supplementation. Arch Dis Child 59: 945–950

    Google Scholar 

  34. Ekblad H, Kero P, Takala J, Korvenranta H, Välimäki I (1987) Water, sodium and acid-base balance in premature infants: theapeutical aspects. Acta Paediatr Scand 76: 47–53

    Google Scholar 

  35. Lorenz JM, Kleinman LI, Kotagal UR, Reller MD (1982) Water balance in very low-birth-weight infants: relationship to water and sodium intake and effect on outcome. J Pediatr 101: 423–432

    Google Scholar 

  36. Arant BS (1982) Fluid therapy in the neonate-concepts in transition. J Pediatr 101: 387–398

    Google Scholar 

  37. Rees L, Brook CDG, Shaw JCL, Forsling ML (1984) Hyponatraemia in the first week of life in preterm infants. I. Arginine vasopressin secretion. Arch Dis Child 59: 414–422

    Google Scholar 

  38. Rees L, Shaw JCL, Brook CDG, Forsling ML (1984) Hyponatraemia in the first week of life in preterm infants. II. Sodium and water balance. Arch Dis Child 59: 423–429

    Google Scholar 

  39. Wiriyathian S, Rosenfeld CR, Arant BS Jr, Porter JC, Faucher DJ, Engle WD (1986) Urinary arginine vasopressin: pattern of excretion in the neonatal period. Pediatr Res 20: 103–108

    Google Scholar 

  40. Coulthard MG, Hey EN (1985) Effect of varying water intake on renal function in healthy premature babies. Arch Dis Child 60: 614–620

    Google Scholar 

  41. Sulyok E, Gyódi G, Ertl T, Bódis J, Hartmann G (1985) The influence of NaCl supplementation on the postnatal development of urinary excretion of noradrenaline, dopamine and serotonin in premature infants. Pediatr Res 19: 5–8

    Google Scholar 

  42. Ertl T, Sulyok E, Varga L, Csaba IF (1983) Postnatal development of plasma prolactin level in premature infants with and without NaCl supplementation. Biol Neonate 44: 219–223

    Google Scholar 

  43. Tulassay T, Rascher W, Seyberth HW, Lang RE, Tóth M, Sulyok E (1986) Role of atrial natriuretic peptide in sodium homeostasis in premature infants. J Pediatr 109: 1023–1027

    Google Scholar 

  44. Tulassay T, Seri I, Rascher W (1987) Atrial natriuretic peptide and extracellular volume contraction after birth. Acta Paediatr Scand 76: 444–446

    Google Scholar 

  45. Atkinson SA, Radde IC, Anderson GH (1983) Macromineral balances in premature infants fed their own mothers' milk or formula. J Pediatr 102: 99–106

    Google Scholar 

  46. Chance GW, Radde IC, Willis DM, Roy RN, Park E, Ackerman J (1977) Postnatal growth of infants of <1.3 kg birth weight: effects of metabolic acidosis, of caloric intake and of calcium, sodium and phosphate supplementation. J Pediatr 91: 787–793

    Google Scholar 

  47. Gross SJ (1983) Growth and biochemical response of preterm infants fed human milk or modified infant formula. N Engl J Med 308: 237–241

    Google Scholar 

  48. Bursey RG, Watson ML (1983) The effect of sodium restriction during gestation on offspring brain development in rats. Am J Clin Nutr 37: 43–51

    Google Scholar 

  49. Aviv A, Kobayashi T, Higashino H, Bauman JW, Yu SS (1982) Chronic sodium deficit in the immature rat: its effect on adaptation to sodium excess. Am J Physiol 242: E241-E247

    Google Scholar 

  50. Wassner SJ (1989) Altered growth and protein turnover in rats fed sodium-deficient diets. Pediatr Res 26: 608–613

    Google Scholar 

  51. Wassner SJ (1991) The effect of sodium repletion on growth and protein turnover in sodium-depleted rats. Pediatr Nephrol 5: (in press)

  52. Lucas A, Gore SM, Cole TJ, Bamford MF, Dossetor JFB, Barr I, Dicarlo L, Cork S, Lucas PJ (1984) Multicentre trial on feeding low birthweight infants: effects of diet on early growth. Arch Dis Child 59: 722–730

    Google Scholar 

  53. Lucas A, Morley R, Cole TJ, Gore SM, Lucas PJ, Crowle P, Pearse R, Boon AJ, Powell R (1990) Early diet in preterm babies and developmental status at 18 months. Lancet 335: 1477–1481

    Google Scholar 

  54. Aperia A, Broberger O, Thodenius K, Zetterström R (1972) Renal response to an oral sodium load in newborn fullterm infants. Acta Paediatr Scand 61: 670–676

    Google Scholar 

  55. Aperia A, Broberger O, Thodenius K, Zetterström R (1974) Developmental study of the renal response to an oral salt load in preterm infants. Acta Paediatr Scand 63: 517–524

    Google Scholar 

  56. Drillien CM (1978) The first feed of low birthweight infants: changing attitudes in the twentieth century (letter). Arch Dis Child 53: 604–605

    Google Scholar 

  57. Lambert HJ, Coulthard MG, Palmer JM, Baylis PH, Matthews JNS (1990) Control of sodium and water balance in the preterm neonate (abstract). Pediatr Nephrol 4: C53

    Google Scholar 

  58. Roberts DS, Haycock GB, Dalton RN, Turner C, Tomlinson P, Stimmler L, Scopes JW (1990) Prediction of acute renal failure after birth asphyxia. Arch Dis Child 65: 1021–1028

    Google Scholar 

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Authors and Affiliations

  1. Department of Pacdiatrics, United Medical and Dental Schools of Guy's and St. Thomas's Hospitals (Guy's Campus), Guy's Hospital, SE1 9RT, London, UK

    George B. Haycock

  2. Department of Pediatrics, Karolinska Institutet, St. Göran's Children's Hospital, S-112 81, Stockholm, Sweden

    Anita Aperia

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  1. George B. Haycock
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Haycock, G.B., Aperia, A. Salt and the newborn kidney. Pediatr Nephrol 5, 65–70 (1991). https://doi.org/10.1007/BF00852850

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  • DOI: https://doi.org/10.1007/BF00852850

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