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

Fabio R Salerno; Alireza Akbari; Sandrine Lemoine; Timothy J Scholl; Christopher W McIntyre; Guido Filler

doi:10.1007/s00467-022-05600-7

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

Pediatr Nephrol. 2023 Feb;38(2):499-507. doi: 10.1007/s00467-022-05600-7. Epub 2022 Jun 2.

Authors

Fabio R Salerno^{1

2}, Alireza Akbari^{3

4}, Sandrine Lemoine^{3

5}, Timothy J Scholl^{6

4

7}, Christopher W McIntyre^{6

3

8}, Guido Filler^{3

8

9

10}

Affiliations

¹ Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada. fabior.salerno@gmail.com.
² The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada. fabior.salerno@gmail.com.
³ The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, ON, Canada.
⁴ Robarts Research Institute, Western University, London, ON, Canada.
⁵ Claude Bernard Lyon 1 University, Lyon, France.
⁶ Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁷ Ontario Institute for Cancer Research, Toronto, ON, Canada.
⁸ Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
⁹ Department of Pathology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
¹⁰ Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.

PMID: 35655040
DOI: 10.1007/s00467-022-05600-7

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

Keywords: CKD; Etiology; Tissue sodium concentration.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acidosis, Renal Tubular*
Adolescent
Adult
Causality
Child
Humans
Pilot Projects
Renal Insufficiency, Chronic*
Risk Factors
Sodium

Substances

Sodium