Renal Function in Early Childhood in Very Low Birthweight Infants

Silvia Iacobelli; Sabrina Loprieno; Francesco Bonsante; Giuseppe Latorre; Luigi Esposito; Jean Bernard Gouyon

doi:10.1055/s-2007-992173

American Journal of Perinatology, Table of Contents

Am J Perinatol 2007; 24(10): 587-592
DOI: 10.1055/s-2007-992173

Renal Function in Early Childhood in Very Low Birthweight Infants

Silvia Iacobelli¹ , Sabrina Loprieno² , Francesco Bonsante¹ , Giuseppe Latorre² , Luigi Esposito² , Jean Bernard Gouyon¹

¹Department of Paediatrics, University of Dijon, France
²NICU and Neonatology, Miulli Hospital, Acquaviva delle Fonti, Italy

Abstract

ABSTRACT

We evaluated renal function in early childhood in 48 very low birthweight (VLBW) ex-preterms and correlated the perinatal risk factors for acute renal failure (ARF) and postnatal growth course to abnormal renal findings at children-age. Nineteen boys and 29 girls (6.3 to 8.2 years of age) had a physical examination, exploration of renal function, and ultrasound. Cases were compared with age-matched controls that were born full term. All patients had normal blood pressure, renal ultrasound, and kidney length to body height. Plasma creatinine and clearance were normal, and no differences were observed with controls. No correlation was found between childhood renal parameters and perinatal variables. Versus controls, 8.3% had pathological microalbuminuria (ACR > 20 mg/g; p = 0.19). Analysis of risk factors for ARF showed that hypotension during neonatal life had a significant independent association with ACR > 20 mg/g at children-age (p = 0.009). Microalbumin excretion and ACR > 20 mg/g strongly correlated with weight z score at 12 months (R, 0.48; 0.21 < R < 0.68) and weight catch-up growth at 6 months (R, 0.38; 0.09 < R < 0.61) and 12 months (R, 0.56; 0.32 < R < 0.74) of corrected age. In conclusion, in VLBW infants, acute conditions such as hypotension and early catch-up growth correlate in childhood to subtle changes in renal function, which can provide early information about the risk of kidney disease in this population.

KEYWORDS

Preterm - renal follow-up - hyperfiltration - microalbuminuria - catch-up growth - weight z score

Full Text

References

REFERENCES

1 Guignard J P, Gouyon J B, John E G. Vasoactive factors in the immature kidney. Pediatr Nephrol. 1991; 5 443-446
2 Toth-Heyn P, Drukker A, Guignard J P. The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol. 2000; 14 227-239
3 Barker D J, Osmond C, Golding J, Kuth D, Wadsworth M E. Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease. BMJ. 1989; 298 564-567
4 Brenner B M, Chertow G M. Congenital oligonephropathy and the etiology of adult hypertension and progressive renal injury. Am J Kidney Dis. 1994; 23 171-175
5 Kistner A, Celsi G, Vanpee M, Jacobson S H. Increased systolic daily ambulatory blood pressure in adult women born preterm. Pediatr Nephrol. 2005; 2 232-233
6 Barker D J, Eriksson J G, Forsen T, Osmond C. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol. 2002; 31 1235-1239
7 National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents . The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics. 2004; 114 555-576
8 Dinkel E, Ertel M, Dittrich M, Perters H, Berres M, Sculte-Wissermann H. Kidney size in childhood: sonographical growth charts for kidney length and volume. Pediatr Radiol. 1985; 15 38-43
9 Assadi F K. Quantitation of microalbuminuria using random urine samples. Pediatr Nephrol. 2002; 17 107-110
10 Redon J. Measurement of microalbuminuria-what the nephrologist should know. Nephrol Dial Transplant. 2006; 21 573-576
11 Oken E, Kleinman K P, Rich-Edwards J, Gillman M W. A nearly continuous measure of birth weight for gestational age using a United States national reference. BMC Pediatr. 2003; 3 6
12 National Center for Health Statistic. CDC growth charts. 2000 Available at http://www.cdc.gov/growthcharts/ Accessed March 2006
13 Schwartz G J, Haydock G B, Edelman C M, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976; 58 259-263
14 No authors listed. The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. The International Neonatal Network. Lancet. 1993; 342 193-198
15 Stapleton F B, Jones D P, Green R S. Acute renal failure in neonates: incidence, etiology and outcome. Pediatr Nephrol. 1987; 1 314-320
16 Sorof J M, Turner J, Frabco K, Portman R J. Characteristics of hypertensive children identified by primary care referral compared with school-based screening. J Pediatr. 2004; 144 485-489
17 Mackenzie H S, Lawler E V, Brenner B M. Congenital oligonephropathy: The fetal flaw in essential hypertension?. Kidney Int Suppl. 1996; 55 S30-S34
18 Drukker A. Oligonephropathy: from a rare childhood disorder to a possible health problem in the adult. Isr Med Assoc J. 2002; 4 191-195
19 Brenner B M, Anderson S. The interrelationships among filtration surface area, blood pressure, and chronic renal disease. J Cardiovasc Pharmacol. 1992; 19(Suppl 6) S1-S7
20 Ojala R, Ala-Houlala M, Ahonen S et al.. Renal follow-up of premature infants with and without perinatal indomethacin exposure. Arch Dis Child Fetal Neonatal. 2001; 84 F28-F33
21 Rodriguez-Soriano J, Aguirre M, Oliveros R, Vallo A. Long-term renal follow-up of extremely low birth weight infants. Pediatr Nephrol. 2005; 20 579-584
22 Lambersheerspink H J, Brinkman J W, Bakker S J, Gansevoort R T, deZeeuw D. Update on microalbuminuria as a biomarker in renal and cardiovascular disease. Curr Opin Nephrol Hypertens. 2006; 15 631-636
23 Keijzer-Veen M G, Schrevel M, Finken M JJ et al.. Microalbuminuria and lower glomerular filtration rate at young adult age in subjects born very premature and after intrauterine growth retardation. J Am Soc Nephrol. 2005; 16 2762-2768
24 Yudkin J S, Martin C N, Philips D I, Gale C R. Associations of microalbuminuria with intra-uterine growth retardation. Nephron. 2001; 89 309-314
25 Eriksson J G, Forsen T, Tuomilehto J, Osmond C, Barker D JP. Fetal and childhood growth and hypertension in adult life. Hypertension. 2000; 36 790-794
26 Barker D JP, Eriksson J G, Forsen T, Osmond C. Fetal origins of adult disease: strength of effects and biological basis. Int J Epidemiol. 2002; 31 1235-1239
27 Bergel E, Haelterman E, Belizan J, Villar J, Carroli G. Perinatal factors associated with blood pressure during childhood. Am J Epidemiol. 2000; 151 594-601

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