RENAL FUNCTION AND CHRONIC KIDNEY DISEASE DEVELOPMENT IN INFANTS AND TODDLERS WITH NEPHROCALCINOSIS: A SYSTEMATIC REVIEW

 

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RENAL FUNCTION AND CHRONIC KIDNEY DISEASE DEVELOPMENT IN INFANTS AND TODDLERS WITH NEPHROCALCINOSIS: A SYSTEMATIC REVIEW

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Nicholas
Ariandi
Nicholas Ariandi nickhizk@gmail.com Universitas Pelita Harapan Faculty of Medicine Tangerang Indonesia *
Dexter Harsono dexterjh0604@gmail.com Universitas Pelita Harapan Faculty of Medicine Tangerang Indonesia -
David Frankson 01071250078@student.uph.edu Universitas Pelita Harapan Faculty of Medicine Tangerang Indonesia -
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Nephrocalcinosis (NC) is the deposition of calcium salts in the kidney parenchymal tissue, most commonly in the medulla. Nephrocalcinosis occurs most frequently in infants and toddlers, particularly in preterm neonates. During this stage, the kidneys are still developing and long-term impacts of nephrocalcinosis on kidney development remains uncertain, with the potential for lasting nephron damage. There are limited data quantifying renal outcomes, such as estimated Glomerular Filtration Rate (eGFR), and risk of Chronic Kidney Disease (CKD). This systematic review aims to evaluate the renal functions, measured by eGFR, and development of CKD in infants and toddlers (aged 0–3 years old) diagnosed with NC to assess the risk of long-term renal dysfunction.

A literature search was conducted in PubMed and PubMed Central using the following search terms: (“Nephrocalcinosis”) AND (“infants” OR “toddlers” OR “children”) AND (“eGFR” OR “renal function” OR “CKD”). Studies included are observational cohorts within 5 years involving infants and toddlers (0 – 3 years old) diagnosed with nephrocalcinosis, where the outcomes reported are eGFR levels and CKD development (stages 1–5, including End-Stage Renal Disease (ESRD)). Reviews and meta-analyses were excluded, and the quality of data was evaluated using the Newcastle–Ottawa Scale (NOS).


A total of 5 studies with a total of 511 participants met the applied inclusion criteria. ⅘ of the studies received a score of 5/9 and 1 study received 6/9 stars on the NOS. The overall study quality is fair, with moderate risk of bias. Most of the limitations are related to comparison groups and adequacy of follow-up. The overall findings showed that most infants and toddlers with NC had median eGFR levels within or near the normal range (80–120 ml/min/1.73m2) at follow up. 2 studies showed no statistically significant difference in eGFR, suggesting stable renal function, while 1 study showed significant difference in improvement. Another study showed a mild, mean decline of approximately 10 ml/min/1.73m2 in eGFR for patients with no improvement in NC grade. 

For CKD development, our findings showed varied results. One study reported that approximately 8.5% of patients developed CKD, and another study found that 22.7% of patients either progressed to ESRD (6.7%) or died due to CKD complications (16%). These findings show that a small subset of patients have higher risks of significant renal dysfunction, particularly those with persistent NC and metabolic and tubular disorders.

Generally, infants and toddlers with nephrocalcinosis maintain eGFR levels within the normal range, suggesting stability in renal function. However, a small group of patients, particularly those with persistent NC and metabolic and tubular disorders, have higher risk of progression to CKD, highlighting the increased risk of long-term renal dysfunction and the need for regular monitoring. Larger, long-term prospective studies are required to improve assessment of functional renal outcomes and long-term risk.

Kewords