Natalia Konstantelos1,2, Tonny Banh1, Viral Patel2, Jovanka Vasilevska-Ristovska1, Karlota Borges1, Neesha Hussain-Shamsy2, Damien Noone2,3, Diane Hebert2,3, Seetha Radhakrishnan2,3, Christoph P B Licht2,3, Valerie Langlois2,3, Rachel J Pearl2,3,4, Rulan S Parekh5,6,7,8,9. 1. Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada. 2. University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada. 3. Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. 4. Department of Pediatrics, William Osler Health System, 101 Humber College Blvd, Etobicoke, ON, M9V 1R8, Canada. 5. Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada. rulan.parekh@sickkids.ca. 6. University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada. rulan.parekh@sickkids.ca. 7. Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. rulan.parekh@sickkids.ca. 8. University Health Network, 101 College St, Toronto, ON, M5G 1L7, Canada. rulan.parekh@sickkids.ca. 9. Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada. rulan.parekh@sickkids.ca.
Abstract
BACKGROUND: Low birth weight (LBW)/prematurity have been proposed as risk factors for the development of kidney disease in adulthood. Whether there is an association between LBW/prematurity and poor renal outcomes in childhood onset nephrotic syndrome remains unknown. METHODS: Children with nephrotic syndrome diagnosed between 1 and 18 years of age were followed prospectively from 1996 to 2016 at The Hospital for Sick Children (N = 377). LBW/prematurity was defined as birth weight < 2500 g or gestational age < 36 weeks. Normal birth weight (NBW) was defined as birth weight ≥ 2500 g. Measures evaluating clinical course of nephrotic syndrome include initial steroid-resistant nephrotic syndrome (SRNS), time to first relapse, and frequently relapsing nephrotic syndrome. Kaplan-Meier survival analysis, logistic regression, and Cox proportional hazards regression were used to determine the association of LBW/prematurity with clinical outcomes. RESULTS: Median birth weights in LBW/premature (n = 46) and NBW (n = 331) children were 2098 g (interquartile range [IQR] 1700-2325 g) and 3317 g (IQR 2977-3685 g), respectively. Odds of having SRNS were 3.78 (95% confidence interval [CI] 1.28-11.21) times higher among LBW/premature children than NBW children. An 8% decrease in odds of developing SRNS was observed for every 100 g increase in birth weight (adjusted odds ratio [OR] 0.92; 95% CI 0.86-0.98). Median time to first relapse did not differ (hazard ratio [HR] 0.89; 95% CI 0.53-1.16). CONCLUSIONS: LBW/premature children were more likely to develop SRNS but did not have a difference in time to first relapse with NBW children. Understanding the impact and mechanism of birth weight and steroid-resistant disease needs further study.
BACKGROUND:Low birth weight (LBW)/prematurity have been proposed as risk factors for the development of kidney disease in adulthood. Whether there is an association between LBW/prematurity and poor renal outcomes in childhood onset nephrotic syndrome remains unknown. METHODS:Children with nephrotic syndrome diagnosed between 1 and 18 years of age were followed prospectively from 1996 to 2016 at The Hospital for Sick Children (N = 377). LBW/prematurity was defined as birth weight < 2500 g or gestational age < 36 weeks. Normal birth weight (NBW) was defined as birth weight ≥ 2500 g. Measures evaluating clinical course of nephrotic syndrome include initial steroid-resistant nephrotic syndrome (SRNS), time to first relapse, and frequently relapsing nephrotic syndrome. Kaplan-Meier survival analysis, logistic regression, and Cox proportional hazards regression were used to determine the association of LBW/prematurity with clinical outcomes. RESULTS: Median birth weights in LBW/premature (n = 46) and NBW (n = 331) children were 2098 g (interquartile range [IQR] 1700-2325 g) and 3317 g (IQR 2977-3685 g), respectively. Odds of having SRNS were 3.78 (95% confidence interval [CI] 1.28-11.21) times higher among LBW/premature children than NBW children. An 8% decrease in odds of developing SRNS was observed for every 100 g increase in birth weight (adjusted odds ratio [OR] 0.92; 95% CI 0.86-0.98). Median time to first relapse did not differ (hazard ratio [HR] 0.89; 95% CI 0.53-1.16). CONCLUSIONS: LBW/premature children were more likely to develop SRNS but did not have a difference in time to first relapse with NBW children. Understanding the impact and mechanism of birth weight and steroid-resistant disease needs further study.
Entities:
Keywords:
Low birth weight; Nephrotic syndrome; Prematurity; Steroid resistant nephrotic syndrome; Time to first relapse
Authors: Lieke A Hoogenboom; Tim G A M Wolfs; Matthias C Hütten; Carine J Peutz-Kootstra; Michiel F Schreuder Journal: Pediatr Nephrol Date: 2020-09-03 Impact factor: 3.714