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Background: Reduction in oxygen delivery to developing kidneys of premature infants may be an important source for acute kidney injury in premature infants. Purpose: To describe changes in continuous kidney oxygenation (RrSO2) measures before, during, and after routine diaper changes. Methods: Non–a priori analysis of a prospective cohort that received continuous measurement of RrSO2 with near-infrared spectroscopy (NIRS) over the first 14 days of life demonstrating acute RrSO2 drops surrounding diaper changes. Results: In total, 26 of 38 (68%) infants (≤1800 g) from our cohort exhibited acute drops in RrSO2 that temporally correlated with diaper changes. Mean (SD) RrSO2 baseline prior to each diaper change event was 71.1 (13.2), dropped to 59.3 (11.6) during diaper change, and recovered to 73.3 (13.2). There was a significant difference between means when comparing baseline to diaper change (P < .001; 95% CI, 9.9 to 13.8) and diaper change to recovery (P < .001; 95% CI, −16.9 to −11.2). The mean decrease in RrSO2 during diaper change averaged 12 points (17%) below 15-minute RrSO2 mean prior to diaper change, with quick recovery to prediaper change levels. No decreases in SpO2, blood pressure, or heart rate were documented during the intermittent kidney hypoxic events. Implications for Practice and Research: Routine diaper changes in preterm infants may increase the risk for acute reductions in RrSO2 as measured by NIRS; however, the impact on kidney health remains unknown. Larger prospective cohort studies assessing kidney function and outcomes related to this phenomenon are needed. [ABSTRACT FROM AUTHOR]

Background: Sickle cell disease (SCD) and autosomal dominant polycystic kidney disease (ADPKD) are relatively common genetic conditions with considerable overlap in clinical presentation. In addition to similarities between the signs and symptoms in sickle cell nephropathy and ADPKD, more than half of SCD patients have kidney cysts. The co-occurrence of these two diseases has not been previously reported in the literature. Case diagnosis/treatment: A 16-year-old Black male with SCD had bilateral kidney enlargement and multiple simple cysts on ultrasound. Although kidney cysts are significantly more common in individuals affected with SCD, genetic testing with a broad kidney gene panel was performed to explore the possible presence of another underlying genetic cause of his cysts, in addition to SCD. A dual diagnosis of SCD and ADPKD was made following the identification of two copies of the common pathogenic sickle cell HBB variant (c.20A > T, p.Glu7Val) and a pathogenic missense variant in PKD1 (c.8311G > A, p.Glu2771Lys). Conclusions: SCD and ADPKD differ in pathophysiological mechanisms and treatment regimens. As such, it will be paramount for this teenager to be closely monitored for signs of diminished kidney function and to be co-managed as he transitions to adult care to ensure proper treatment and management. Early identification of individuals with both SCD and a co-occurring condition is crucial to ensuring proper clinical management. Furthermore, identifying and reporting additional patients with SCD and ADPKD dual diagnoses will help us to understand the co-occurring disease course and optimal treatments. [ABSTRACT FROM AUTHOR]

Background: Currently, reference ranges for renal oxygenation measured by near-infrared spectroscopy (NIRS) in preterm infants beyond the first days of life are lacking, especially those born prior to 29 weeks' gestation. Population estimates of renal oxygenation (rSO 2 ) levels among preterm infants over time have yet to be established, leading to reluctance in clinical application.Purpose: To characterize the distribution and estimate population parameters for renal oxygenation measured by NIRS during the first 14 days of life among preterm infants.Methods: We prospectively observed rSO 2 trends of 37 infants before 34 weeks' gestation and 1800-g or less birth weight for the first 14 days of life. Analyses included distribution fit tests, ordinary least squares (OLS) regression, and t tests.Results: Average daily rSO 2 variation steadily increased with 42% difference through the first 14 days of life. For all infants, renal rSO 2 means peaked during the first 3 days of life and plateaued around 7 days. Daily rSO 2 slopes were significantly lower among males and infants 29 weeks' or less gestation.Implications For Practice: Renal rSO 2 during the first 14 days of life reflects normal extrauterine transition reaching stabilization around 7 days of life. Gestational age, birth weight, and gender may predict the early trajectory of rSO 2 patterns. Population estimates provide parameters for renal rSO 2 that may indicate early-onset tissue hypoxia when acute or significant drops from baseline occur.Implications For Research: We present a framework to guide future research using renal NIRS technology in preterm infants to determine deviations from expected trends that may precede renal injury. [ABSTRACT FROM AUTHOR]