Effect of Intrauterine Growth Retardation on the Clinical Course and Prognosis of IgA Glomerulonephritis in Children

Abstract

Intrauterine growth retardation (IUGR) resulting in a reduced number of nephrons is one of the nonimmune mechanisms that have been recently proposed as contributing to the progression of renal diseases. The purpose of our study was to determine whether IUGR has any effect on the clinical course and prognosis of IgA glomerulonephritis (IgA GN) in children. Fifty children with biopsy-proven IgA GN, who were followed for at least 3 years, were included. Six of the 50 children (12%) had signs of IUGR at birth, defined as birth weight below the 10th percentile for gestational age. There were no significant differences in initial clinical presentation between children with IUGR and those without IUGR. However, in kidney biopsy specimens, we found a significantly higher mean percentage of sclerotic glomeruli in children with IUGR than in those without IUGR (33 vs. 13%, p < 0.015). At the end of the follow-up period, we observed a significantly higher incidence of arterial hypertension in children with IUGR than in those without IUGR (50 vs. 11%, p < 0.05). Other differences between the two groups of children were not statistically significant. In conclusion, our study demonstrated an increased risk of the development of arterial hypertension and glomerulosclerosis in children with IgA GN who had suffered from IUGR with a birth weight below the 10th percentile for gestational age. IUGR may therefore help to identify early in the course of IgA GN those children who are at higher risk of an unfavorable course.

Glomerular Density in Renal Biopsy Specimens Predicts the Long-Term Prognosis of IgA Nephropathy

“…Some studies have suggested that there is substantial variation in the nephron number in normal people without renal diseases (20,21). It is interesting that a low nephron number was shown to be associated with low birth weight, which was also shown to be associated with poor outcome of glomerular diseases, including IgAN (22)(23)(24). The second possibility is an effect of aging.…”

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 effect of intrauterine environment and low glomerular number on the histological changes in diabetic glomerulosclerosis

“…Congenital nephron deficits may interact with environmental and genetic factors to generate glomerulosclerosis [35]. In children with nephrotic syndrome [36] or IgA nephropathy [37], those with intrauterine growth retardation had higher blood pressure and more rapidly progressive disease than those of normal birth weight.…”