PATHOPHYSIOLOGY OF RENAL-GU ANOMALIES--IN UTERO COCAINE

肾谷异常的病理生理学--子宫内可卡因

• 批准号: 3247855
• 负责人: JOSE STRAUSS
• 金额: $ 23.86万
• 依托单位: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 1992
• 资助国家: 美国
• 起止时间: 1992-09-30 至 1995-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3247855
• 关键词: African American; cocaine; congenital kidney disorder; congenital reproductive system disorder; drug abuse; embryo /fetus toxicology; gestational age; glomerular filtration rate; histopathology; human subject; infant human (0-1 year); kidney disorder diagnosis; kidney function; kidney imaging /visualization; longitudinal human study; maternal behavior; newborn human (0-6 weeks); renal tubule acidosis; reproductive system disorder diagnosis; urinalysis

The number of in utero cocaine-exposed infants is high and rising; so are their health-related problems. The objective of this study is to determine the impact of this exposure on the renal-genitourinary (GU) system, congenital anomalies and function changes in the newborn, infant, and child. The association between maternal cocaine use and adverse effects on renal-GU morphogenesis and function will be assessed shortly after birth and subsequently in a prospective longitudinal study. The study population (N-500) will include a group of in utero cocaine-exposed term infants (N=250), a control group (N=125) which is unexposed to cocaine but exposed to alcohol/marijuana, and a control group (N=125) which is drug-free. The three groups will be drawn from an initial survey population of 2,250 North American black women delivering at the University of Miami/Jackson Memorial Medical Center (UM/JMMC). A detailed maternal substance abuse history, urine and hair toxicology, and serum testing for HIV-1 will be performed at delivery. Newborn infants meconium toxicology assays will be performed shortly after delivery. Infants whose mothers test positive for HIV-1 antibodies will not be included in the study. Infant kidney growth, anatomy, and glomerular and tubular functions will be assessed. A complete physical examination with emphasis on abdomen, genitalia and blood pressure, and urinalysis, urine culture, serum electrolytes, CO2, BUN, creatinine, urine electrolytes, creatinine, and Beta 2 microglobulin will be performed during the delivery hospitalization and at 12 and 24 months. Infants with abnormal findings, plus a subset of 20 randomly selected cocaine-exposed infants and 20 controls (10 in each of two groups) without abnormal findings, will undergo further evaluation of glomerular filtration rate by cold iothalamate clearance, and tubular function by urine acidification. All enrolled infants will have anatomy evaluation by Doppler ultrasound performed shortly after birth and at 12 and 24 months of age. Infants with abnormal anatomy findings will be tested with Mag 3 diuretic renal scan and manometric nuclear voiding cystogram. Also, Mag 3 diuretic renal scan will be performed during the first month of life and at 12 and 24 months in different subsets of 20 cocaine exposed infants and 10 alcohol-marijuana controls. The individual cocaine-exposed infant's benefit will be early identification of renal-GU malformations and/or functional anomalies, improvement of clinical management possibilities, and minimization of future complications. The overall benefit will be definition of the long-term effect of in utero cocaine exposure on the renal-GU system, increased information about renal-GU response to insult, and perhaps greater understanding of renal-GU growth and development.

子宫内接触可卡因的婴儿数量很高，而且还在增加；也是如此 他们的健康相关问题。 本研究的目的是 确定该暴露对肾泌尿生殖系统 (GU) 的影响 新生儿、婴儿的系统、先天性异常和功能变化， 和孩子。 母亲使用可卡因与不良反应之间的关联 对肾-GU形态发生和功能的影响将很快得到评估 出生后以及随后的前瞻性纵向研究。 这 研究人群 (N-500) 将包括一组在子宫内接触过可卡因的人 足月婴儿 (N=250)，对照组 (N=125) 未暴露于 可卡因但接触酒精/大麻，以及对照组 (N=125) 这是不含药物的。 这三组将从最初的抽签中选出 对 2,250 名在该医院分娩的北美黑人妇女进行了调查 迈阿密大学/杰克逊纪念医学中心 (UM/JMMC)。 一个 详细的母亲药物滥用史、尿液和头发毒理学，以及 HIV-1 血清检测将在分娩时进行。 新生婴儿 胎便毒理学检测将在分娩后不久进行。 母亲 HIV-1 抗体检测呈阳性的婴儿将不会 纳入研究。 婴儿肾脏的生长、解剖学和肾小球 将评估肾小管功能。 进行完整的身体检查 重点关注腹部、生殖器和血压以及尿液分析、尿液 培养、血清电解质、CO2、BUN、肌酐、尿电解质、 肌酐和 Beta 2 微球蛋白将在检查期间进行 分娩住院以及 12 个月和 24 个月时。 患有异常的婴儿 研究结果，加上随机选择的 20 名接触过可卡因的婴儿的子集 20 名对照组（两组各 10 名）无异常发现， 将通过冷法进一步评估肾小球滤过率 碘丘氨酸清除率和尿液酸化影响肾小管功能。 全部 登记的婴儿将通过多普勒超声进行解剖学评估 出生后不久以及 12 个月和 24 个月大时进行。 婴儿 解剖结构异常的患者将接受 Mag 3 利尿肾测试 扫描和测压核排尿膀胱造影。 另外，Mag 3 利尿剂 肾脏扫描将在出生后第一个月以及 12 岁和 12 岁进行 20 名接触过可卡因的婴儿和 10 名接触过可卡因的婴儿的不同子集的 24 个月 酒精大麻管制。 接触可卡因的婴儿个体 好处是及早发现肾 GU 畸形和/或 功能异常，改善临床管理的可能性， 并最大限度地减少未来的并发症。 总体效益将是 子宫内可卡因暴露对胎儿的长期影响的定义 肾 GU 系统，增加有关肾 GU 对损伤反应的信息， 或许还能更好地了解肾 GU 的生长和发育。