Renal consequences of preterm birth

Abstract

BackgroundThe developmental origin of health and disease concept identifies the brain, cardiovascular, liver, and kidney systems as targets of fetal adverse programming with adult consequences. As the limits of viability in premature infants have been pushed to lower gestational ages, the long-term impact of prematurity on kidneys still remains a significant burden during hospital stay and beyond.ObjectivesThe purpose of this study is to summarize available evidence, mechanisms, and short- and long-term renal consequences of prematurity and identify nephroprotective strategies and areas of uncertainty.ResultsKidney size and nephron number are known to be reduced in surviving premature infants due to disruption of organogenesis at a crucial developmental time point. Inflammation, hyperoxia, and antiangiogenic factors play a role in epigenetic conditioning with potential life-long consequences. Additional kidney injury from hypoperfusion and nephrotoxicity results in structural and functional changes over time which are often unnoticed. Nephropathy of prematurity and acute kidney injury confound glomerular and tubular maturation of preterm kidneys. Kidney protective strategies may ameliorate growth failure and suboptimal neurodevelopmental outcomes in the short term. In later life, subclinical chronic renal disease may progress, even in asymptomatic survivors.ConclusionAwareness of renal implications of therapeutic interventions and renal conservation efforts may lead to a variety of short and long-term benefits. Adequate monitoring and supplementation of microelement losses, gathering improved data on renal handling, and exploration of new avenues such as reliable markers of injury and new therapeutic strategies in contemporary populations, as well as long-term follow-up of renal function, is warranted.

Mast cells—Good guys with a bad image?

“…167,168,124 F I G U R E 2 Role of mast cells for reproductive processes. [186][187][188] However, there is a recent study reporting opposite results as a significant lower number of MCs in the decidua of patients suffering from preterm birth was observed when compared to samples obtained from term births. A well-balanced physiological number and activation of uMCs is important for reproductive processes including ovulation, implantation, tissue remodeling, decidualization, spiral artery remodeling, placentation, fetal development, and uterus contractions that are in turn relevant for giving birth.…”

“…185,126 Preterm delivery is a global health problem that is associated with high incidence of perinatal and neonatal death and with short-and long-term health consequences later in life. [186][187][188] However, there is a recent study reporting opposite results as a significant lower number of MCs in the decidua of patients suffering from preterm birth was observed when compared to samples obtained from term births. 189 The exact understanding of the role of MCs in processes underlying initiation and maintaining of pregnancy as well as induction of birth are important to prevent pregnancy pathologies on the one hand and for the development of effective treatment options on the other hand and need to be focused on future research.…”

Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants

“…All these conditions may induce renal hypoperfusion and hypoxia [7-9]. As focused on in very recent reviews, not only the assessment of renal function is often limited and difficult in preterm infants [5, 10], but additionally, kidney hypoperfusion preceding renal dysfunction may be subclinical [11]. So, research of early markers of both renal injury and hypoperfusion is advocated.…”

Pharmacokinetics and bioavailability of cefquinome and ceftriaxone in premature calves

“…Another study reported that the excretion extent of CFQ correlated with glomerular filtration rate in dogs; however, data in calves are not available (Taverne, van Geijlswijk, Heederik, Wagenaar, & Mouton, 2016). The rapid elimination of the drug in premature calves could be due to increased cardiac output, which would lead to an increase in glomerular filtration rate (Stritzke, Thomas, Amin, Fusch, & Lodha, 2017). These cardiovascular changes F I G U R E 2 Semi-logarithmic plasma concentration-time curves of ceftriaxone following intravenous (IV) and intramuscular (IM) administrations at a dose of 20 mg/kg in premature calves (n = 6, mean ± SD) may be caused due to hypoxia associated with premature birth (Aydogdu et al, 2016).…”