Osamu Uemura1,2,3, Kenji Ishikura4,5, Tetsuji Kaneko6, Daishi Hirano7, Yuko Hamasaki8, Masao Ogura4, Naoaki Mikami9, Yoshimitsu Gotoh10, Takeshi Sahashi11, Naoya Fujita12, Masaki Yamamoto13, Satoshi Hibino12, Masaru Nakano14, Yasuhiro Wakano11, Masataka Honda9. 1. Department of Clinical Medicine, Japanese Red Cross Toyota College of Nursing, Toyota, Japan. o_uemura@hkg.odn.ne.jp. 2. Department of Pediatrics, Ichinomiya Medical Treatment & Habilitation Center, 1679-2 Tomida-nagaresuji, Ichinomiya-city, Aichi, 494-0018, Japan. o_uemura@hkg.odn.ne.jp. 3. Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Japan. o_uemura@hkg.odn.ne.jp. 4. Division of Nephology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan. 5. Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan. 6. Department of Clinical Research, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan. 7. Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan. 8. Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan. 9. Department of Pediatric Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 10. Department of Pediatric Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan. 11. Department of Pediatrics, Ichinomiya Municipal Hospital, Ichinomiya, Japan. 12. Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Nagoya, Japan. 13. Department of Pediatrics, Seirei Hamamatsu General Hospital, Hamamatsu, Japan. 14. Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan.
Abstract
BACKGROUND: Developmental programming of chronic kidney disease (CKD) in young adults is linked to preterm birth and intrauterine growth restriction (IUGR). Which confers a higher risk of progression to chronic kidney damage in children with very low birth weight (VLBW; born weighing < 1500 g): prematurity or IUGR? METHODS: This is a national historical cohort study of children with VLBW cared for in perinatal medical centers in Japan. Predictive factors included three latent variables (prematurity, IUGR, stress during neonatal period) and eight observed variables (gestational age, birth weight Z-score, maternal age, duration of treatment with antibiotics and diuretics, maternal smoking, late-onset circulatory collapse, kidney dysfunction) during the perinatal period. The primary endpoint was estimated glomerular filtration rate (eGFR) at age ≥ 3 years. A structural equation model was used to examine the pathologic constitution. RESULTS: The 446 children with VLBW included 253 boys and 193 girls, of mean age 5.8 ± 2.6 years and mean eGFR 111.7 ml/min/1.73 m2 at last encounter. Pathway analyses showed intrauterine malnutrition (β = 0.85) contributed more to chronic kidney damage than stress during the neonatal period (β = - 0.19) and prematurity (β = 0.12), and kidney dysfunction and late-onset circulatory collapse were important observed variables in stress during the neonatal period. CONCLUSIONS: IUGR was more harmful to future kidneys of VLBW neonates. Neonatal kidney dysfunction and late-onset circulatory collapse were important risk factors for subsequent CKD development. This emphasizes the need for obstetricians to monitor for fetal growth restriction and neonatologists to minimize neonatal stress to prevent CKD in later life.
BACKGROUND: Developmental programming of chronic kidney disease (CKD) in young adults is linked to preterm birth and intrauterine growth restriction (IUGR). Which confers a higher risk of progression to chronic kidney damage in children with very low birth weight (VLBW; born weighing < 1500 g): prematurity or IUGR? METHODS: This is a national historical cohort study of children with VLBW cared for in perinatal medical centers in Japan. Predictive factors included three latent variables (prematurity, IUGR, stress during neonatal period) and eight observed variables (gestational age, birth weight Z-score, maternal age, duration of treatment with antibiotics and diuretics, maternal smoking, late-onset circulatory collapse, kidney dysfunction) during the perinatal period. The primary endpoint was estimated glomerular filtration rate (eGFR) at age ≥ 3 years. A structural equation model was used to examine the pathologic constitution. RESULTS: The 446 children with VLBW included 253 boys and 193 girls, of mean age 5.8 ± 2.6 years and mean eGFR 111.7 ml/min/1.73 m2 at last encounter. Pathway analyses showed intrauterine malnutrition (β = 0.85) contributed more to chronic kidney damage than stress during the neonatal period (β = - 0.19) and prematurity (β = 0.12), and kidney dysfunction and late-onset circulatory collapse were important observed variables in stress during the neonatal period. CONCLUSIONS: IUGR was more harmful to future kidneys of VLBW neonates. Neonatal kidney dysfunction and late-onset circulatory collapse were important risk factors for subsequent CKD development. This emphasizes the need for obstetricians to monitor for fetal growth restriction and neonatologists to minimize neonatal stress to prevent CKD in later life.
Authors: Maria M Rodríguez; Alexander H Gómez; Carolyn L Abitbol; Jayanthi J Chandar; Shahnaz Duara; Gastón E Zilleruelo Journal: Pediatr Dev Pathol Date: 2004 Jan-Feb