TY - JOUR
T1 - Does protein intake correlate with tubular function in very preterm neonates?
AU - Puspitasari, Henny Adriani
AU - Trihono, Partini Pudjiastuti
AU - Wahidiyat, Pustika Amalia
N1 - Funding Information:
This work was partially supported by a Publikasi Terindeks Internasional Sains dan Teknologi Kesehatan (PUTI Saintekes) research grant from the University of Indonesia, Indonesia [Grant number: NKB-2195/UN2.RST/HKP.05.00/2020]. The authors declare no competing financial interests. and report no conflicts of interest in this work.
Funding Information:
The authors would like to thank the NICU staff and nurses of CMGH and BMH for their cooperation in specimen collection. We also thank Dr. Yoga Devaera, Sp.A(K) for her substantial contribution to the nutritional interpretation of the data; Dr. Rosalina D Roeslani, Sp.A(K) for her contribution to the neonatology aspect of the study protocol; Dr. Dejandra Rasnaya for data collection; and Dr. Sudung O Pardede, Sp.A(K) and Dr. Ninik Asmaningsih, Sp.A(K) for their critical evaluation of the discussion. We would also like to thank Diashati R Mardiasmo, MD for her involvement in the statistical analyses, manuscript assistance and English services.This work was partially supported by a Publikasi Terindeks Internasional Sains dan Teknologi Kesehatan (PUTI Saintekes) research grant from the University of Indonesia, Indonesia [Grant number: NKB-2195/UN2.RST/HKP.05.00/2020]. The authors declare no competing financial interests. and report no conflicts of interest in this work.
Publisher Copyright:
© 2023, Indonesian Pediatric Society Publishing House. All rights reserved.
PY - 2023/8/28
Y1 - 2023/8/28
N2 - Background High protein intake in very preterm neonates (VPN) is important for growth. However, preterm kidneys have fewer functional nephrons and many of the ones present may be imma-ture. Studies have shown that high protein intake induces nephron hypertrophy, proteinuria, and glomerular sclerosis, which lead to tubular injury. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker that is released during proximal tubular cell injury. The uNGAL to creatinine (uNGAL/Cr) ratio is com-monly performed for normalization. Objective To assess for a possible association between protein intake and uNGAL/Cr ratio in VPN. Methods A prospective cohort study was conducted in two NICUs in Jakarta. Subjects’ urine specimens were collected at 0-48 hours, 72 hours, and 21 days after birth to determine uNGAL/Cr ratio as a biomarker of tubular injury. Protein was administered according to study sites NICU guidelines. Protein intake was recorded daily from 14-21 days of age for formula and measured twice with a human milk analyzer for breast milk. ELISA was used to mea-sure uNGAL concentration. Low protein intake was defined as <3g/kg/day and high protein intake was defined as ≥3g/kg/day. Maternal and perinatal variables were recorded from medical records. Results Fifty-nine VPN were recruited, of whom 39 completed the study. Median uNGAL/Cr ratio ranged from 0.32-104.11 ng/ mg. The uNGAL/Cr ratio was not correlated with protein intake but was inversely correlated with gestational age and birth weight [r=-0.320, P=0.019 for the 72-hr (T2) urinary collection]. Higher uNGAL/Cr levels were associated with maternal infection [14.4 (range 4.4-104.1) vs. 7.2 (range 0.5-32.4) ng/mg, P=0.004 at the 0-48-hr (T1)], maternal anemia [6.9 (range 1.2-66.6) vs. 1.7 (range 0.3-89.2) ng/mg, P=0.001 at the 21-day (T3)] and nephrotoxic medication [15.9 (range 1.3-63.8) vs. 1.0 (range 0.4-8.6) ng/mg, P=0.026 at the 72-hr]. Conclusion Protein intake according to current nutritional guidelines does not correlate with tubular injury in VPN, as measured by uNGAL/Cr ratio. Maternal infection, maternal anemia, lower birth weight, and nephrotoxic medication, are associated with higher uNGAL/Cr levels in VPN.
AB - Background High protein intake in very preterm neonates (VPN) is important for growth. However, preterm kidneys have fewer functional nephrons and many of the ones present may be imma-ture. Studies have shown that high protein intake induces nephron hypertrophy, proteinuria, and glomerular sclerosis, which lead to tubular injury. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker that is released during proximal tubular cell injury. The uNGAL to creatinine (uNGAL/Cr) ratio is com-monly performed for normalization. Objective To assess for a possible association between protein intake and uNGAL/Cr ratio in VPN. Methods A prospective cohort study was conducted in two NICUs in Jakarta. Subjects’ urine specimens were collected at 0-48 hours, 72 hours, and 21 days after birth to determine uNGAL/Cr ratio as a biomarker of tubular injury. Protein was administered according to study sites NICU guidelines. Protein intake was recorded daily from 14-21 days of age for formula and measured twice with a human milk analyzer for breast milk. ELISA was used to mea-sure uNGAL concentration. Low protein intake was defined as <3g/kg/day and high protein intake was defined as ≥3g/kg/day. Maternal and perinatal variables were recorded from medical records. Results Fifty-nine VPN were recruited, of whom 39 completed the study. Median uNGAL/Cr ratio ranged from 0.32-104.11 ng/ mg. The uNGAL/Cr ratio was not correlated with protein intake but was inversely correlated with gestational age and birth weight [r=-0.320, P=0.019 for the 72-hr (T2) urinary collection]. Higher uNGAL/Cr levels were associated with maternal infection [14.4 (range 4.4-104.1) vs. 7.2 (range 0.5-32.4) ng/mg, P=0.004 at the 0-48-hr (T1)], maternal anemia [6.9 (range 1.2-66.6) vs. 1.7 (range 0.3-89.2) ng/mg, P=0.001 at the 21-day (T3)] and nephrotoxic medication [15.9 (range 1.3-63.8) vs. 1.0 (range 0.4-8.6) ng/mg, P=0.026 at the 72-hr]. Conclusion Protein intake according to current nutritional guidelines does not correlate with tubular injury in VPN, as measured by uNGAL/Cr ratio. Maternal infection, maternal anemia, lower birth weight, and nephrotoxic medication, are associated with higher uNGAL/Cr levels in VPN.
KW - protein
KW - tubular injury
KW - urinary neutrophil gelatinase-associated lipocalin
KW - very preterm neonates
UR - http://www.scopus.com/inward/record.url?scp=85169830961&partnerID=8YFLogxK
U2 - 10.14238/pi63.4.2023.245-55
DO - 10.14238/pi63.4.2023.245-55
M3 - Article
AN - SCOPUS:85169830961
SN - 0030-9311
VL - 63
SP - 245
EP - 255
JO - Paediatrica Indonesiana(Paediatrica Indonesiana)
JF - Paediatrica Indonesiana(Paediatrica Indonesiana)
IS - 4
ER -