Preserved renal function during long-term follow-up in children with chronic liver disease

Abstract

Aim: We have previously found well-maintained renal function in children with new-onset chronic liver disease. In this study, we investigated their renal function during long-term follow-up of the disease.

Methods: In a study of 289 children with chronic liver disease, renal function was investigated as glomerular filtration rate (GFR) measured as clearance of inulin or iohexol. Yearly change in GFR was calculated based on a linear mixed model. The data were analysed with regard to different subgroups of liver disease and with regard to the outcome.

Results: The initially well-preserved renal function remained so in most patients during the observation period, even in children with progressive liver disease leading to decompensation. The greatest fall in GFR occurred in patients with initial hyperfiltration. Cholestasis seemed to have a nephroprotective effect.

Conclusion: Chronic liver disease in childhood seems to have less impact on renal function than believed earlier, at least as long as the liver function remains compensated. Regular renal check-ups remain an essential tool for optimal patient care. Hyperfiltration seems to predict decline in renal function. Otherwise no further reliable prognostic markers were found in patients whose liver disease was not decompensated.

Keywords: chronic liver disease; clearance of inulin or iohexol; glomerular filtration rate; infants and children.