Effect of Intrauterine Growth Retardation on the Progression of Nephrotic Syndrome

Abstract

Background/Aim: Neonates with intrauterine growth retardation (IUGR) experience higher morbidity and mortality rates than appropriate-for-gestational-age (AGA) neonates. The purpose of our study was to clarify whether IUGR has any influences on the progression of nephrotic syndrome in children. Methods: We performed a retrospective review of 56 children with nephrotic syndrome. IUGR was defined as a birth weight less than the tenth percentile for gestational age. Among 56 patients having nephrotic syndrome, 8 had IUGR, and 48 were AGA. Results: The 24-hour urinary protein level in children with IUGR was significantly higher than that in children who were AGA (7.61 ± 6.75 vs. 3.92 ± 3.70 g/day, p < 0.05). There was a statistically significant difference in the incidence of steroid resistance (62.5 vs. 10.4%, p < 0.05) and in the time to remission (median 60 vs. 13 days, p < 0.05) between the children with IUGR and those being AGA. Also, there was a significant difference in the incidences of treatment with cytotoxic agents (75 vs. 29.2%, p < 0.05) and complications such as hypertension. Conclusions: Our report indicates that IUGR predicts an unfavorable progression of nephrotic syndrome. So, it is important for nephrologists to pay attention to the clinical course of nephrotic syndrome in neonates with IUGR.

Effect of Intrauterine Growth Restriction on Kidney Function at Young Adult Age: The Nord Trøndelag Health (HUNT 2) Study

“…This could explain associations of low BW with such clinical outcomes as albuminuria, low-normal kidney function, and ESRD. [6][7][8][9][10][11][12][13][14][15][16][17]37 However, these are only a few studies, sometimes with a weak design, and the effects found were not strong. Case-control studies showed an OR of 1.5 for ESRD in subjects with BWs less than 2,500 g, but data for BW were missing in half the cases.…”

“…[8][9][10] The clinical consequences of these alterations were investigated at different levels, and associations were found of IUGR with microalbuminuria, 11,12 faster progression of renal dysfunction in patients with specific kidney diseases, 13,14 and end-stage renal disease (ESRD). 15,16 Because IUGR also was associated with other diseases, such as type 2 diabetes mellitus, it is difficult to disentangle direct from indirect effects of IUGR on advanced renal failure.…”

The Clinical Importance of Nephron Mass

“…67,115,132 More rapid progression or relative resistance to therapy was also observed in LBW individuals with IgA nephropathy, membranous nephropathy, minimalchange disease, nephrotic syndrome, and chronic pyelonephritis. [132][133][134][135][136][137][138] Among a predominantly black dialysis population, the odds ratio for ESRD was 1.4 (95% confidence interval 1.1 to 1.8) among those with LBW compared with those with NBW. 16 This relationship persisted for all causes of ESRD and was not affected by family history of ESRD.…”

Nephron Number, Hypertension, Renal Disease, and Renal Failure

“…Furthermore, adults with the lowest kidney volumes, examined in the context of current weight, had the highest rates of albuminuria and highest BP (23), tending to support a role of nephron underdosing in these pathologies. Lower birth weights have been associated with higher relapse rates in children with the nephrotic syndrome (86,87) and with progression in children with IgA nephropathy (88). Associations of birth weight with renal deaths are obscured by the competing effects of the higher numbers of cardiovascular and other nonrenal natural deaths that are predicted by renal markers (75)(76)(77)89) and by deficient documentation of the contribution of renal disease to natural deaths (90).…”