Renal function and blood pressure are altered in adolescents born preterm

Am, South; Pa, Nixon; Mc, Chappell; Diz, D. I.; Gb, Russell; Jensen, E.L. Leknes; Shaltout, Hossam A.; Tm, O'Shea; Lk, Washburn

doi:10.1007/s00467-018-4050-z

Cited by 55 publications

(67 citation statements)

References 40 publications

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“…This can be an issue in women born with very low birth weight, a population known to have a reduced nephron number and to be particularly prone to developing FSGS. [17][18][19][20][21] These studies point to the importance of hemodynamic factors, namely pregnancyrelated hyperfiltration, in the pathogenesis of lesions. However, in keeping with what has been observed in patients with cancer treated with antiangiogenic drugs, it is possible that the imbalance between angiogenic and antiangiogenic factors is a contributing factor.…”

Section: Introductionmentioning

confidence: 99%

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Guillén

Silva

González

et al. 2019

American Journal of Kidney Diseases

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The relationship between focal segmental glomerulosclerosis (FSGS) and pregnancy is complex and not completely elucidated. Pregnancy in patients with FSGS poses a high risk for complications, possibly due to hemodynamic factors, imbalance between angiogenic and antiangiogenic factors, and hormonal conditioning. Although poor clinical outcomes associated with collapsing FSGS are common outside of pregnancy, the prognosis during pregnancy is not well documented. We report 3 patients who developed collapsing FSGS during pregnancy, 2 of whom had presumed underlying FSGS. Two patients underwent biopsy during pregnancy, and 1, during the puerperium. None of the 3 patients improved spontaneously after delivery, and 1 experienced a rapid deterioration in kidney function and proteinuria after delivery. Aggressive immunosuppressive therapy led to a full response in 1 case (without chronic lesions) and to partial responses in the remaining 2 cases. These cases suggest that collapsing lesions should be considered in patients with FSGS who develop a rapid increase in serum creatinine level or proteinuria during pregnancy and that these lesions may at least partially respond to treatment.

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Section: Introductionmentioning

confidence: 99%

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Guillén

Silva

González

et al. 2019

American Journal of Kidney Diseases

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“…Our study identified dysregulated blood pressure as a long-term consequence of premature birth, with transgenerational inheritance up to the third generation. Several studies have already reported high blood pressure in former preterm infants, as early as in infancy or adolescence 7 . Developmental programming of cardiovascular diseases was first described by Barker et al, who proposed that early events occurred during the perinatal period, i.e., preterm birth could adversely impact organogenesis or ontogenesis of signaling pathways and be responsible for long-term cardiovascular alterations in adulthood 26 .…”

Section: Discussionmentioning

confidence: 99%

“…Renal developmental alterations may also impact renal structure and function until adulthood and induce compensatory glomerulomegaly, renin-angiotensinaldosterone system (RAAS) activation and glomerulosclerosis, according to the Brenner hypothesis 6 . Former preterm infants are indeed prone to developing hypertension, as early as in adolescence 7 , which leads to a global cardiovascular risk increase in this population.…”

Section: Introductionmentioning

confidence: 99%

Preterm birth is associated with epigenetic programming of transgenerational hypertension in mice

et al. 2020

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Renal and cardiovascular complications of prematurity are well established, notably the development of hypertension in adulthood. However, the underlying molecular mechanisms remain poorly understood. Our objective was to investigate the impact of prematurity on the ontogenesis of renal corticosteroid pathways, to evaluate its implication in perinatal renal complications and in the emergence of hypertension in adulthood. Swiss CD1 pregnant mice were injected with lipopolysaccharides at 18 days of gestation (E18) to induce prematurity at E18.5. Pups were sacrificed at birth, 7 days and 6 months of life. Second (F2) and third (F3) generations, established by mating prematurely born adult females with wild-type males, were also analyzed. Former preterm males developed hypertension at M6 (P < 0.0001). We found robust activation of renal corticosteroid target gene transcription at birth in preterm mice (αENaC (+45%), Gilz (+85%)), independent of any change in mineralocorticoid or glucocorticoid receptor expression. The offspring of the preterm group displayed increased blood pressure in F2 and F3, associated with increased renal Gilz mRNA expression, despite similar MR or GR expression and plasma corticosteroid levels measured by LC-MS/MS. Gilz promoter methylation measured by methylated DNA immunoprecipitation-qPCR was reduced with a negative correlation between methylation and expression (P = 0.0106). Our study demonstrates prematurity-related alterations in renal corticosteroid signaling pathways, with transgenerational inheritance of blood pressure dysregulation and epigenetic Gilz regulation up to the third generation. This study provides a better understanding of the molecular mechanisms involved in essential hypertension, which could partly be due to perinatal epigenetic programming from previous generations.

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“…La asociación entre RN prematuro y presión arterial (PA) más elevada parece estar bien establecida, aunque no claramente como hipertensión arterial (HTA), para lo cual podría requerirse más tiempo de seguimiento 1,2,13,15 . En el caso de adolescentes y adultos jóvenes nacidos prematuramente varios estudios han observado mayores tasas de PA elevada e HTA, e inversamente proporcional a la prematurez del nacimiento 16,17 . En un pequeño estudio local en escolares nacidos muy prematuramente (menores de 32 sema-nas EG o menos de 1.500 g al nacer), el registro de monitoreo ambulatorio de PA (MAPA) demostró una alta prevalencia de alteraciones, principalmente la ausencia de diferencia de PA día vs noche, lo que se relaciona con mayor riesgo de progresión a HTA 18 .…”

Section: A Hipertensión Arterialunclassified

El riñón del niño prematuro: riesgos a largo plazo

2020

Rev Chil Pediatr

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El recién nacido prematuro se enfrenta a las condiciones extrauterinas con sistemas aún inmaduros, tanto anatómica como fisiológicamente. El riñón termina de desarrollarse a finales del tercer trimestre del embarazo, por lo que está especialmente expuesto a alterar su desarrollo normal en caso de nacer en forma prematura. Esta situación puede condicionar, entre otras consecuencias, una menor masa renal funcional y cambios microvasculares que representan un riesgo elevado de hipertensión arterial y daño renal crónico en el largo plazo. En el presente artículo se analiza la evidencia existente actual sobre estos riesgos en los prematuros y se ofrece un esquema de seguimiento de estos niños desde el punto de vista nefrológico.

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Renal function and blood pressure are altered in adolescents born preterm

Abstract: Prematurity was associated with higher BP and reduced renal function that were detectable in adolescence. OWO and sex may modify the strength of these relationships.

Cited by 55 publications

References 40 publications

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Collapsing Lesions and Focal Segmental Glomerulosclerosis in Pregnancy: A Report of 3 Cases

Preterm birth is associated with epigenetic programming of transgenerational hypertension in mice

El riñón del niño prematuro: riesgos a largo plazo

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