Low birth weight, but not postnatal weight gain, aggravates the course of nephrotic syndrome

Abstract

Clinical and animal studies have shown a higher risk of an aggravated course of renal disease in childhood after birth for babies small for gestational age (SGA). In addition relative "supernutrition" and fast weight gain in early infancy seem to support the development of later disease. In a retrospective analysis of 62 cases of idiopathic nephrotic syndrome treated between 1994 and 2004 at a university centre for paediatric nephrology, we related the course of disease to birth weight and to the weight gain in the first 2 years of life. Six children were born SGA (birth weight <-1.5 standard deviation score), and 56 were born as appropriate for gestational age (AGA). In all SGA children renal biopsy was performed, while only 55% of the AGA children underwent renal biopsy (P = 0.07), showing no difference in renal histology. In the SGA group, four of six patients developed steroid resistance (vs 12/56 AGA, P < 0.05). Of the SGA children, 83% needed antihypertensive treatment in the course of the disease compared to 39% of the AGA children (P = 0.07). The extent of weight gain between birth and 24 months of age did not influence the course of disease. In conclusion, we were able to find evidence for an aggravated course of idiopathic nephrotic syndrome in former SGA children. Independently of birth weight, weight gain in the first 2 years of life did not influence the course of disease.

Serum Creatinine Levels Are Significantly Influenced by Renal Size in the Normal Pediatric Population

“…Small-for-gestational age children with steroid-dependent nephrotic syndrome, for example, tend to develop a more severe course of disease (20). Likewise, it has been shown that small-for-gestational age pediatric patients with IgA nephropathy are at higher risk of developing chronic renal failure (21).…”

Intrauterine Growth Restriction following Ligation of the Uterine Arteries Leads to More Severe Glomerulosclerosis after Mesangioproliferative Glomerulonephritis in the Offspring

“…In various renal diseases, like membranous nephropathy in adults [27] , IgA nephropathy in children [6] , idiopathic nephrotic syndrome in children [3,4] , renal damage after urinary tract infection [28] and diabetic nephropathy [29,30] , an association between low birth weight as a marker for an unfavorable intrauterine milieu and a later aggravated course of renal disease was described. In another experimental study, infusion of advanced glycation end-products in former IUGR rats increased renal mRNA expression of profibrotic cytokines and procollagen III [31] .…”

“…N A 1.5/ V V 0.5 with k = 1 and ␤ = 1.382. Total cortex volume (V cortex ) was derived from kidney mass divided by the specific weight of the kidney (1.04 g/cm 3 ) times the volume density of the cortex. The total number of glomeruli was derived from the total volume of the renal cortex and the number of glomeruli per cortex volume: N glom = N V !…”

“…Retrospective clinical studies have demonstrated that children with idiopathic nephrotic syndrome who were born small for gestational age (SGA) have a higher incidence of relapses, steroid dependency and steroid resistance than children with a history of normal birth weight [1][2][3] . Former SGA children with idiopathic nephrotic syndrome also have a higher need for additional immunosuppressive therapy, such as alkylating agents and cyclosporin A [4] .…”

Placental 11β-HSD2 Gene Expression at Birth Is Inversely Correlated With Growth Velocity in the First Year of Life After Intrauterine Growth Restriction

“…Low birth weight is associated with an increased risk for short stature, insulin resistance, childhood obesity, premature adrenarche, hypertension, and renal disease (1)(2)(3). The process leading to these diseases in later child-or adulthood is called perinatal programming (4).…”