Microalbuminuria and Lower Glomerular Filtration Rate at Young Adult Age in Subjects Born Very Premature and after Intrauterine Growth Retardation

Abstract

This prospective follow-up study of 422 19-yr-old subjects born very preterm in The Netherlands was performed to determine whether intrauterine growth retardation (IUGR) predisposes to abnormal GFR and microalbuminuria in adolescents. GFR (ml/min per 1.73 m 2 ) was estimated using the Cockcroft-Gault equation, and albumin-creatinine ratio (mg/mmol) was calculated in a cohort of 19-yr-old subjects born very preterm (gestational age <32 wk) in 1983. Birth weights were adjusted for gestational age and expressed as standard deviation scores (sds) as a measure of IUGR. All subjects had normal renal function. Birth weight (sds) was associated negatively with serum creatinine concentration (mol/L) (␤ ‫؍‬ ؊1.0 mol/L, 95% confidence interval [CI]: ؊1.9 to ؊0.2), positively with GFR (␤ ‫؍‬ 3.0, 95% CI: 1.7 to 4.2), and negatively with the logarithm of albumin-creatinine ratio (␤ ‫؍‬ ؊0.05, 95% CI: ؊0.09 to ؊0.01) in young adults born very preterm. IUGR is associated with unfavorable renal functions at young adult age in subjects born very premature. These data suggest that intrauterine growth-retarded subjects born very premature have an increased risk to develop progressive renal failure in later life.

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

“…7,[34][35][36] We found that IUGR was associated with low-normal kidney function in young adults from the general population. This is consistent with findings in subjects born very prematurely 17 . A low nephron number was observed in low-BW subjects at autopsy.…”

“…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.…”

“…For that reason, follow-up studies of younger populations are necessary. A relationship between IUGR and renal function at 19 years of age was found in a prospective cohort study of subjects born very premature, 17 however, to date, no cohort study investigated the effect of IUGR on young adult kidney function in a general population.…”

Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease

“…Several studies have tried to dissect the relative roles of prematurity and growth restriction. Some authors suggest prematurity alone is the predominant risk factor, whereas others have found SGA to be more important in determining risk of higher blood pressure and kidney disease 57 . These differences likely reflect the complex interplay of intra-and extra-uterine events and timing of insults which vary considerably in premature infants 12 .…”

Aortic Wall Thickness and Amniotic Fluid Albuminuria in Growth-Restricted Twin Fetuses

“…Singh and Hoy (2004) described an association between low birth weight, kidney size, and albuminuria in Aboriginal Australians between 4 and 72 years of age. Recently, the Keijzer-Veen et al (2005) prospective follow-up study reported an association between the severity of IUGR and renal function in young adults who were born very prematurely. On average, their low birth weight was associated with lower glomerular filtration rates, higher serum creatinine concentrations, and higher microalbumin secretion at the age of 19.…”