Renal processing of glucose in well and sick neonates
Malcolm G Coulthard, Edmund N Hey
Department of Child
Health Royal Victoria Infirmary
Newcastle upon Tyne NE1
4LP
Correspondence to: Dr M G Coulthard.
Accepted 7 April
1999
AIMS
To determine the
extent of renal processing of glucose in sick and well neonates.
METHODSGlomerular
filtration rate (GFR) and the renal processing of glucose, sodium, and
water were measured using prolonged inulin infusion in 47 infants of
26-40 weeks of gestation, aged 1-13 days.
RESULTSGFR rose by
15% after ventilatory support was withdrawn, and was unaffected by
clinical instability. Fractional glucose excretion was low in the
stable unventilated babies except at very high filtered loads, but rose
in one unstable, unventilated baby. It was higher in ventilated babies,
and remained high for at least six days after ventilation. For water
and sodium, net differences between intake and urine excretion were not
affected by ventilation, clinical stability, or glycosuria.
CONCLUSIONSA
combination of a low GFR and a high fluid intake, urine flow, and urine
concentrating capacity, makes neonates very unlikely to develop an
osmotic diuresis due to glycosuria while they have a blood glucose
below 12 mmol/l, despite assertions to the contrary.
Keywords: glomerular filtration rate; renal glucose; renal sodium; osmotic diuresis
© 1999 by Archives of Disease in Childhood
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