Does Extremely Low Birth Weight Predispose to Low-Renin Hypertension?

Abstract

Abstract-Low birth weight and prematurity are risk factors for hypertension in adulthood. Few studies in preterm or fullterm born children reported on plasma renin activity (PRA). We tested the hypothesis that renin might modulate the incidence of hypertension associated with prematurity. We enrolled 93 prematurely born children with birth weight <1000 g and 87 healthy controls born at term, who were all examined at ≈11 years. Renal length and glomerular filtration rate derived from serum cystatin C were 0.28 cm (95% confidence interval, 0.09-0.47) and 11.5 mL/min per 1.73 m 2 (6.4-16.6) lower in cases, whereas their systolic/diastolic blood pressure (BP) was 7.5 mm Hg (4.8-10.3)/4.0 mm Hg (2.1-5.8) higher (P<0.001 for all). The odds of having systolic prehypertension or systolic hypertension associated with extreme low birth weight were 6.43 (2.52-16.4; P<0.001) and 10.9 (2.46-48.4; P=0.002). Twenty-four hours of urinary sodium excretion was similar in cases and controls (102.1 versus 106.8 mmol; P=0.47). Sodium load per nephron was estimated as sodium excretion divided by kidney length (mmol/cm). PRA was 0.54 ng/mL per hour (0.23-0.85; P=0.001) lower in cases. PRA, systolic BP, and sodium load were available in 43 cases and 56 controls. PRA decreased with systolic BP (slope −0.022 ng/ mL per hour/ −mm Hg ; P=0.048), but was unrelated to sodium load (slope +0.13 mmol/cm −mm Hg ; P=0.54). The slope of PRA on systolic BP was similar (P=0.17) in cases and controls. In conclusion, extremely low birth weight predisposes young adolescents to low-renin hypertension, but does not affect the inverse association between PRA and BP. Clinical Trial Registration-URL: https://www.clinicaltrials.gov. Unique identifier: NCT02147457.

Ibuprofen exposure in early neonatal life does not affect renal function in young adolescence

“…Although renal function (smaller kidney length, higher cystatin C, lower eGFR cysC ) was significantly different in ELBW cases compared with term-born age-matched controls in young adolescence,7 we were unable to unveil any impact of perinatal risk factors—including ibuprofen exposure—or postdischarge growth patterns on these markers of altered renal function within this ELBW cohort.…”

“…The mean renal length was 0.28 cm shorter (8.73 (0.65) vs 9.01 (0.59) cm) in cases while cystatin C (0.96 (0.12) vs 0.87 (0.11) mg/dL) and estimated glomerular filtration rate (eGFR cysC ) (97.2 (13.6) vs 108.7 (15.3) mL/min/1.73 m 2 ) were shifted by about 1 SD in ELBW cases compared with controls (all p≤0.01) 7. We aimed to link these biomarkers of renal function in ELBW cases during young adolescence with their perinatal confounders—including ibuprofen—and postnatal growth characteristics in a post hoc analysis to explore associations to retrieve potential safety signals 3 7 8.…”

“…Renal function was assessed based on renal ultrasound and eGFR cysC 7. The renal ultrasound was performed with participants in supine, left or right decubitus, using a Vivid7 Pro (GE 125 Vingmed, Horten, Norway) interfaced with a 1.5–4.5 MHz convex transducer according to standardised procedures.…”

Glomerular Filtration Rate in Former Extreme Low Birth Weight Infants over the Full Pediatric Age Range: A Pooled Analysis

“…Following the search strategy described, 248 (232 + 16) hits were analyzed to result in 6 casecontrol and 3 ELBW cohort studies for the analysis [Figure 1]. The key characteristics of the individual case-control studies are provided in Table 1 [12][13][14][15][16][17][18], cohort studies in Table 2 [19][20][21]. Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 19 January 2020 doi:10.20944/preprints202001.0213.v1…”

Endothelial Colony‐Forming Cells in Young Adults Born Preterm: A Novel Link Between Neonatal Complications and Adult Risks for Cardiovascular Disease

“…In addition, the mechanisms linking hypertension and ECFC dysfunction are still unknown. Beyond the hypothesis of a cause/effect relationship between ECFC dysfunction and elevated blood pressure, ECFC dysfunction and hypertension may result from common physiopathological pathways, such as the activation of the autonomic nervous system, renin–angiotensin system, and inflammation,45 which in turn were all previously shown to be altered in preterm‐born subjects or in experimental models of preterm birth 46, 47, 48, 49, 50, 51, 52, 53. These observations suggest that both ECFC dysfunction and elevated blood pressure could be long‐term consequences of very preterm birth.…”