Unfavorable course of minimal change nephrotic syndrome in children with intrauterine growth retardation

Zidar, Nina; Čavić, Mojca Avguštin; Kenda, Rajko B.; Ferluga, D

doi:10.1046/j.1523-1755.1998.00121.x

Cited by 66 publications

(44 citation statements)

References 20 publications

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“…These cases, however, may be considered examples of the "two-hit " hypothesis, which proposes that the low nephron number (first hit) may influence the presentation and modify the course of a subsequent renal injury (second hit). Indeed, LBW has been associated with a worse outcome in diverse renal diseases, including idiopathic membranous nephropathy, minimal change disease, and IgA nephropathy (23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

Very Low Birth Weight is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis

Hodgin

Rasoulpour

Markowitz

et al. 2009

Clinical Journal of the American Society of Nephrology

214

121

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Background and objectives: Low birth weight (LBW), resulting from intrauterine growth retardation (IUGR) or prematurity, is a risk factor for adult hypertension and chronic kidney disease. LBW is associated with reduced nephron endowment and increased glomerular volume; however, the development of secondary focal segmental glomerulosclerosis (FSGS) has not been reported previously.Design T he index case is a 15-yr-old Caucasian male who was found to have mild proteinuria during routine urinary screening. His birth was complicated by prematurity (23 wk gestational age) and a very low birth weight (1.40 kg). He had had numerous perinatal problems associated with prematurity including respiratory complications, intracranial hemorrhage, necrotizing enterocolitis, bowel obstruction, sepsis, and retinopathy of prematurity. There was no history of hematuria, urinary reflux, renal insufficiency, recent fevers, hearing loss, or familial renal disease. He was taking no medications. The patient was followed for several weeks and was found to have persistent, mild proteinuria not associated with exercise or posture (nonorthostatic).Physical examination revealed a height of 172 cm and a weight of 75 kg (body mass index ϭ 25.4 kg/m 2 ), BP of 127/79 mmHg (90th percentile), and no edema. Renal ultrasound revealed normal-appearing kidneys measuring 10.5 cm and 9.6 cm in length. Laboratory examination showed a hematocrit of 50% (normal ϭ 37% to 45%), white blood cell count 7.8 ϫ 10 9 /L (normal ϭ 4.5 to 13.5 ϫ 10 9 /L) with normal differential, platelet count 221 ϫ 10 9 /L (normal 150 to 450 ϫ 10 9 /L), blood urea nitrogen 15 mg/dl (5.8 mmol/L) (normal ϭ 7 to 18 mg/dl [2.5 to 6.4 mmol/L]), creatinine clearance 100 cc/min, serum creatinine 0.9 mg/dl (75.6 mol/L), total serum protein 7.3 g/dl (73 g/L) (normal 6 to 8.2 g/dl [60 to 82 g/L]), and serum albumin 4.4 g/dl (44 g/L) (normal 3.4 to 5.0 g/dl [34 to 50 g/L]). Serum electrolytes, including sodium, potassium, bicarbonate, chloride, and calcium, were normal. The following serologies were negative: anti-nuclear antibody, anti-double-stranded DNA antibody, hepatitis B surface antigen, and hepatitis C antibody. Serum complement levels, including C3 and C4, were within normal range. Urinalysis revealed a specific gravity of 1.030, pH 5, and protein Ͼ 300 mg/dl, with negative glucose, heme and leukocyte esterase. The 24-h urinary protein was 1.34 g. Microscopic examination of the urine revealed zero to five white blood cells per high-power field, no red blood cells, and no hyaline or granular casts. A renal biopsy was performed to determine the cause of persistent subnephrotic proteinuria.Light microscopic examination showed one core of tissue consisting of renal cortex and a small portion of outer medulla. There were 8 glomeruli, none of which were globally sclerotic. The glomeruli appeared hypertrophied but normocellular, with patent capillaries and glomerular basement membranes of normal thickness. No immune-type fuchsinophilic deposits were identified with the trichrome stain. T...

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Section: Discussionmentioning

confidence: 99%

Very Low Birth Weight is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis

Hodgin

Rasoulpour

Markowitz

et al. 2009

Clinical Journal of the American Society of Nephrology

214

121

View full text Add to dashboard Cite

show abstract

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Tsuboi¹,

Kawamura²,

Koike³

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: An early histopathologic predictor of the renal prognosis, before the occurrence of advanced glomerular sclerosis/interstitial fibrosis and/or apparent renal dysfunction, remains to be established in IgA nephropathy (IgAN). This study aimed to determine whether the glomerular density (GD; nonsclerotic glomerular number per renal cortical area) of biopsy specimens obtained at an early stage of IgAN could predict the long-term renal outcome.Design, setting, participants, & measurements: The predictive value of the factors at biopsy, including the GD, on the renal outcome was retrospectively analyzed for 98 patients who had IgAN with an estimated GFR of >60 ml/min per 1.73 m 2 at biopsy (87 ml/min per 1.73 m 2 on average). Results: The individual value of GD in biopsy ranged from 1.2 to 8.1/mm 2 (i.e., approximately a seven-fold variation), and the GD showed a close inverse correlation with mean glomerular volume. Among the various clinicopathologic factors involved, both a cellular/fibrocellular crescent and the GD were found to be significant predictors of progression in multivariate analyses. A low GD in the biopsy specimens was frequently associated with a steeper slope of the renal function and a synergistically enhanced risk for progression with the presence of cellular/fibrocellular crescent. The renal function, proteinuria, degrees of glomerulosclerosis, and interstitial fibrosis at biopsy were not independent predictors of the prognosis in these patients.Conclusions: A strong predictive relationship of low GD with progression observed in this study suggests that GD may serve as an early histopathologic marker of long-term renal prognosis in IgAN.

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“…Furthermore, adults with the lowest kidney volumes, examined in the context of current weight, had the highest rates of albuminuria and highest BP (23), tending to support a role of nephron underdosing in these pathologies. Lower birth weights have been associated with higher relapse rates in children with the nephrotic syndrome (86,87) and with progression in children with IgA nephropathy (88). Associations of birth weight with renal deaths are obscured by the competing effects of the higher numbers of cardiovascular and other nonrenal natural deaths that are predicted by renal markers (75)(76)(77)89) and by deficient documentation of the contribution of renal disease to natural deaths (90).…”

Section: Low Nephron Number Renal Disease and Renal Failurementioning

confidence: 99%

“…Evaluation through ESRD treatment registries poses problems of selection, especially in developing countries with restricted access; however, a study in the southeastern United States did show that ESRD patients tended to be of lower birth weights than matched controls (91). In some of these studies, the birth weight effect was more pronounced in women (20,83,84,86). Most, too, showed the important effect of higher levels of body fat in postnatal life in educing or exacerbating the adverse effects of lower birth weights, not only on renal disease but also on BP and metabolic profiles.…”

Section: Low Nephron Number Renal Disease and Renal Failurementioning

confidence: 99%

Nephron Number, Hypertension, Renal Disease, and Renal Failure

Hoy¹,

Hughson²,

Bertram³

et al. 2005

Journal of the American Society of Nephrology

288

226

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Unfavorable course of minimal change nephrotic syndrome in children with intrauterine growth retardation

Cited by 66 publications

References 20 publications

Very Low Birth Weight is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis

Very Low Birth Weight is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis

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

Nephron Number, Hypertension, Renal Disease, and Renal Failure

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