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Benagiano M, Mancuso S, Brosens JJ, Benagiano G. Long-Term Consequences of Placental Vascular Pathology on the Maternal and Offspring Cardiovascular Systems. Biomolecules 2021; 11:1625. [PMID: 34827623 PMCID: PMC8615676 DOI: 10.3390/biom11111625] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 12/14/2022] Open
Abstract
Over the last thirty years, evidence has been accumulating that Hypertensive Disorders of Pregnancy (HDP) and, specifically, Preeclampsia (PE) produce not only long-term effects on the pregnant woman, but have also lasting consequences for the fetus. At the core of these consequences is the phenomenon known as defective deep placentation, being present in virtually every major obstetrical syndrome. The profound placental vascular lesions characteristic of this pathology can induce long-term adverse consequences for the pregnant woman's entire arterial system. In addition, placental growth restriction and function can, in turn, cause a decreased blood supply to the fetus, with long-lasting effects. Women with a history of HDP have an increased risk of Cardiovascular Diseases (CVD) compared with women with normal pregnancies. Specifically, these subjects are at a future higher risk of: Hypertension; Coronary artery disease; Heart failure; Peripheral vascular disease; Cerebrovascular accidents (Stroke); CVD-related mortality. Vascular pathology in pregnancy and CVD may share a common etiology and may have common risk factors, which are unmasked by the "stress" of pregnancy. It is also possible that the future occurrence of a CVD may be the consequence of endothelial dysfunction generated by pregnancy-induced hypertension that persists after delivery. Although biochemical and biophysical markers of PE abound, information on markers for a comparative evaluation in the various groups is still lacking. Long-term consequences for the fetus are an integral part of the theory of a fetal origin of a number of adult diseases, known as the Barker hypothesis. Indeed, intrauterine malnutrition and fetal growth restriction represent significant risk factors for the development of chronic hypertension, diabetes, stroke and death from coronary artery disease in adults. Other factors will also influence the development later in life of hypertension, coronary and myocardial disease; they include parental genetic disposition, epigenetic modifications, endothelial dysfunction, concurrent intrauterine exposures, and the lifestyle of the affected individual.
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Affiliation(s)
- Marisa Benagiano
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy
| | - Salvatore Mancuso
- Department of Life Sciences, Catholic University of Rome, 00168 Rome, Italy;
| | - Jan J. Brosens
- Division of Biomedical Sciences, Warwick Medical School, Coventry CV4 7HL, UK;
| | - Giuseppe Benagiano
- Department of Maternal and Child Health, Gynecology and Urology, Sapienza University of Rome, 00185 Rome, Italy;
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Laucyte-Cibulskiene A, Sharma S, Christensson A, Nilsson PM. Early life factors in relation to albuminuria and estimated glomerular filtration rate based on cystatin C and creatinine in adults from a Swedish population-based cohort study. J Nephrol 2021; 35:889-900. [PMID: 34623630 PMCID: PMC8995262 DOI: 10.1007/s40620-021-01159-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
Background Early life factors influence the number of nephrons a person starts life with and a consequence of that is believed to be premature kidney ageing. Thus, we aimed to identify early life factors associated with cystatin C and creatinine-based estimated glomerular filtration (eGFR) rate equations and urine -albumin-to-creatinine ratio after a follow-up of 46–67 years. Methods The study included 593 Swedish subjects without diabetes mellitus from the Malmo Diet Cancer Cohort. Perinatal data records including birth weight, gestational age, placenta weight and maternal related risk factors were analysed. eGFR was determined by Chronic Kidney Disease Epidemiology (CKD-EPI), the Lund-Malmö revised and Caucasian, Asian, Paediatric, and Adult (CAPA) equations. Postnatal growth phenotypes were defined as low (≤ 0) or high (> 0) birth weight z-score, or low (≤ median) or high (> median) body mass index at 20 years of age. Results In women, lower birth weight was associated with lower eGFR (CAPA; CKD-EPI cystatin C). Birth weight z-score predicted adult albuminuria specifically in men (OR 0.75, 95% CI [0.58; 0.96]). Women with high birth weight z-score and low BMI at 20 years had lower eGFR (CAPA; CKD-EPI cystatin C; p = 0.04). Men with high birth weight z-score and high BMI at 20 years had lower risk for albuminuria (OR 0.35, 95% CI [0.12; 0.93]). Conclusions Lower birth weight, prematurity and postnatal growth curve have a potential sex- specific effect of early exposure to an adverse environment on lower cystatin C-based eGFR and albuminuria later in life. Cystatin C compared to creatinine -eGFR equations shows a higher ability to detect these findings. Graphic abstract ![]()
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Affiliation(s)
- Agne Laucyte-Cibulskiene
- Department of Clinical Sciences, Skane University Hospital, Lund University, Ruth Lundskogs gata 14, 205 02, Malmö, Sweden.
- Department of Nephrology, Skane University Hospital, Lund University, 205 02, Malmö, Sweden.
| | - Shantanu Sharma
- Department of Clinical Sciences, Skane University Hospital, Lund University, Ruth Lundskogs gata 14, 205 02, Malmö, Sweden
| | - Anders Christensson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Ruth Lundskogs gata 14, 205 02, Malmö, Sweden
- Department of Nephrology, Skane University Hospital, Lund University, 205 02, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Ruth Lundskogs gata 14, 205 02, Malmö, Sweden
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Hamroun A, Frimat L, Laville M, Metzger M, Combe C, Fouque D, Jacquelinet C, Ayav C, Liabeuf S, Lange C, Herpe YE, Zee J, Glowacki F, Massy ZA, Robinson B, Stengel B. New Insights into Acute-on-Chronic Kidney Disease in Nephrology Patients: The CKD-REIN Study. Nephrol Dial Transplant 2021; 37:1700-1709. [PMID: 34473306 DOI: 10.1093/ndt/gfab249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Acute-on-chronic kidney disease (ACKD) is poorly understood and often overlooked. We studied its incidence, circumstances, determinants, and outcomes in patients with CKD. METHODS We used the Kidney Disease Improving Global Outcomes criteria to identify all-stage acute kidney injury (AKI) events in 3033 nephrology outpatients with CKD stage 3-5 participating in the CKD-REIN cohort study (2013-2020), and cause-specific Cox models to estimate hazard ratios (HR, 95% confidence intervals [CI]) of AKI-associated risk factors. RESULTS At baseline, 22% of the patients (mean age 67 years, 65% men, mean eGFR 32 ml/min/1.73m2) had a history of AKI. Over a 3-year follow-up, 443 had at least one AKI event: 27% were stage 2 or 3, and 11% required dialysis; 74% involved hospitalization including 47% acquired as hospital inpatients; a third were not reported in hospital discharge reports. Incidence rates were 10.1 and 4.8 per 100 person-years in patients with and without an AKI history, respectively. In 2375 patients without this history, male sex, diabetes, cardiovascular disease, cirrhosis, several drugs, low eGFR, and serum albumin levels were significantly associated with a higher risk of AKI, as were low birth weight (<2500 g) (adjusted HR, 1.98; 95%CI, 1.35 to 2.91) and hemoglobin level (HR 1.21; 1.12 to 1.32 per 1 g/dl decrease). Within one year, only 63% of the patients had recovered their previous kidney function, 13.7% had started kidney replacement therapy, and 12.7% had died. CONCLUSIONS The study highlights the high rate of hospital-acquired AKI events in patients with CKD, and their underreporting at hospital discharge. It also reveals low birth weight and anemia as possible new risk factors in CKD patients.
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Affiliation(s)
- Aghilès Hamroun
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France.,Department of Nephrology, Dialysis, and Transplantion, Regional University Hospital Centre of Lille, F-59037 Lille, France
| | - Luc Frimat
- Department of Nephrology, Nancy University Hospital, F-54000 Vandoeuvre-lès-Nancy, France.,Lorraine University, APEMAC, F-54000 Nancy, France
| | - Maurice Laville
- Department of Nephrology, Lyon Sud Hospital, F-69495 Pierre Bénite, France.,Lyon University, INSERM U1060, CarMeN, F-69495 Pierre Bénite, France
| | - Marie Metzger
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France
| | - Christian Combe
- Nephrology Transplantation, Dialysis, Bordeaux University Hospital, F-33076 Bordeaux, France.,Inserm U1026, Bordeaux Segalen University, F-33076 Bordeaux, France
| | - Denis Fouque
- Department of Nephrology, Lyon Sud Hospital, F-69495 Pierre Bénite, France.,Lyon University, INSERM U1060, CarMeN, F-69495 Pierre Bénite, France
| | | | - Carole Ayav
- Department of Clinical Epidemiology, INSERM CIC-EC 1433, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Sophie Liabeuf
- Amiens University Hospital, Clinical Research Centre, Avenue R.Laennec, AMIENS, Picardie, FR 80000
| | - Céline Lange
- Agence de la Biomédecine, La Plaine Saint-Denis, France
| | | | - Jarcy Zee
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | - François Glowacki
- Department of Nephrology, Dialysis, and Transplantion, Regional University Hospital Centre of Lille, F-59037 Lille, France
| | - Ziad A Massy
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France.,Department of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, Paris, France
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
| | - Bénédicte Stengel
- Paris-Saclay University, Versailles Saint Quentin University, Inserm, Clinical Epidemiology Team, CESP, Centre for Research in Epidemiology and Population Health, F-94807 Villejuif, France
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Cullen-McEwen LA, van der Wolde J, Haruhara K, Tribolet L, Dowling JP, Bertram MG, de Matteo R, Haas F, Czogalla J, Okabayashi Y, Armitage JA, Black MJ, Hoy WE, Puelles VG, Bertram JF. Podocyte endowment and the impact of adult body size on kidney health. Am J Physiol Renal Physiol 2021; 321:F322-F334. [PMID: 34308670 DOI: 10.1152/ajprenal.00029.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022] Open
Abstract
Low birth weight is a risk factor for chronic kidney disease, whereas adult podocyte depletion is a key event in the pathogenesis of glomerulosclerosis. However, whether low birth weight due to poor maternal nutrition is associated with low podocyte endowment and glomerulosclerosis in later life is not known. Female Sprague-Dawley rats were fed a normal-protein diet (NPD; 20%) or low-protein diet (LPD; 8%), to induce low birth weight, from 3 wk before mating until postnatal day 21 (PN21), when kidneys from some male offspring were taken for quantitation of podocyte number and density in whole glomeruli using immunolabeling, tissue clearing, and confocal microscopy. The remaining offspring were fed a normal- or high-fat diet until 6 mo to induce catch-up growth and excessive weight gain, respectively. At PN21, podocyte number per glomerulus was 15% lower in low birth weight (LPD) than normal birth weight (NPD) offspring, with this deficit greater in outer glomeruli. Surprisingly, podocyte number in LPD offspring increased in outer glomeruli between PN21 and 6 mo, although an overall 9% podocyte deficit persisted. Postnatal fat feeding to LPD offspring did not alter podometric indexes or result in glomerular pathology at 6 mo, whereas fat feeding in NPD offspring was associated with far greater body and fat mass as well as podocyte loss, reduced podocyte density, albuminuria, and glomerulosclerosis. This is the first report that maternal diet can influence podocyte endowment. Our findings provide new insights into the impact of low birth weight, podocyte endowment, and postnatal weight on podometrics and kidney health in adulthood.NEW & NOTEWORTHY The present study shows, for the first time, that low birth weight as a result of maternal nutrition is associated with low podocyte endowment. However, a mild podocyte deficit at birth did not result in glomerular pathology in adulthood. In contrast, postnatal podocyte loss in combination with excessive body weight led to albuminuria and glomerulosclerosis. Taken together, these findings provide new insights into the associations between birth weight, podocyte indexes, postnatal weight, and glomerular pathology.
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Affiliation(s)
- Luise A Cullen-McEwen
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
| | - James van der Wolde
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
| | - Kotaro Haruhara
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Leon Tribolet
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
- Health and Biosecurity, CSIRO, Geelong, Victoria, Australia
| | - John P Dowling
- Department of Anatomical Pathology, Monash Medical Centre, Clayton, Victoria, Australia
| | - Michael G Bertram
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, Umea, Sweden
- School of Biological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Robert de Matteo
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
| | - Fabian Haas
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Czogalla
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yusuke Okabayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - James A Armitage
- School of Medicine (Optometry) and Institute for Mental and Physical Health and Clinical Translation, Deakin University, Waurn Ponds, Victoria, Australia
| | - M Jane Black
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
| | - Wendy E Hoy
- Centre for Chronic Disease, University of Queensland, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Victor G Puelles
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - John F Bertram
- Stem Cells and Development Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria, Australia
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Yu X, Yuan Z, Lu H, Gao Y, Chen H, Shao Z, Yang J, Guan F, Huang S, Zeng P. Relationship between birth weight and chronic kidney disease: evidence from systematics review and two-sample Mendelian randomization analysis. Hum Mol Genet 2021; 29:2261-2274. [PMID: 32329512 DOI: 10.1093/hmg/ddaa074] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 12/13/2022] Open
Abstract
Observational studies showed an inverse association between birth weight and chronic kidney disease (CKD) in adulthood existed. However, whether such an association is causal remains fully elusive. Moreover, none of prior studies distinguished the direct fetal effect from the indirect maternal effect. Herein, we aimed to investigate the causal relationship between birth weight and CKD and to understand the relative fetal and maternal contributions. Meta-analysis (n = ~22 million) showed that low birth weight led to ~83% (95% confidence interval [CI] 37-146%) higher risk of CKD in late life. With summary statistics from large scale GWASs (n = ~300 000 for birth weight and ~481 000 for CKD), linkage disequilibrium score regression demonstrated birth weight had a negative maternal, but not fetal, genetic correlation with CKD and several other kidney-function related phenotypes. Furthermore, with multiple instruments of birth weight, Mendelian randomization showed there existed a negative fetal casual association (OR = 1.10, 95% CI 1.01-1.16) between birth weight and CKD; a negative but non-significant maternal casual association (OR = 1.09, 95% CI 0.98-1.21) was also identified. Those associations were robust against various sensitivity analyses. However, no maternal/fetal casual effects of birth weight were significant for other kidney-function related phenotypes. Overall, our study confirmed the inverse association between birth weight and CKD observed in prior studies, and further revealed the shared maternal genetic foundation between low birth weight and CKD, and the direct fetal and indirect maternal causal effects of birth weight may commonly drive this negative relationship.
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Affiliation(s)
- Xinghao Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Zhongshang Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, China
| | - Haojie Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Yixin Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Haimiao Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Zhonghe Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Jiaji Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Fengjun Guan
- Department of Pediatrics, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Shuiping Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
| | - Ping Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu 221004, China
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Di Bonito P, Licenziati MR, Campana G, Chiesa C, Pacifico L, Manco M, Miraglia Del Giudice E, Di Sessa A, Baroni MG, Marzuillo P, Valerio G. Prevalence of Mildly Reduced Estimated GFR by Height- or Age-Related Equations in Young People With Obesity and Its Association with Cardiometabolic Risk Factors. J Ren Nutr 2021; 31:586-592. [PMID: 33642186 DOI: 10.1053/j.jrn.2020.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/24/2020] [Accepted: 11/01/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To compare the prevalence of mildly reduced estimated glomerular filtration rate (MRGFR) (eGFR >60 and < 90 mL/min/1.73 m2), calculated by two creatinine-based equations, and its association with cardiometabolic risk factors (CMRF) in youth with overweight (OW)/obesity (OB). METHODS This is a multicenter cross-sectional study involving university and non-university hospital pediatrics departments. We enrolled 3,118 youth with OW/OB (5-14 years) and 286 healthy normal weight (NW) youth. eGFR was calculated using bedside Schwartz equation (eGFRBSE) and Full Age Spectrum equation (eGFRFAS). In OW/OB group we analyzed the association between eGFR calculated by both equations and CMRF. Uric acid (UA) and birth weight were available in 2,135 and in 1,460 youth. RESULTS The prevalence of MRGFR was 3.8% in NW versus 7.8% in OW/OB (P = .016) by eGFRBSE, and 8.7% in NW versus 19.4% in OW/OB (P < .0001) by eGFRFAS. eGFRBSE and eGFRFAS identified 242 and 605 young people with OW/OB with MRGFR, respectively. Individuals with MRGFR according with both equations showed lower birth weight, younger age, higher BMI-SDS, non-high-density lipoprotein-cholesterol and UA as compared to those with normal eGFR. To examine whether the eGFRFAS was associated with a worse CMR profile also in the range of normal eGFRBSE, we reclassified young people with normal eGFRBSE (n = 2,876) according with eGFRFAS. Out of youth with normal eGFRBSE, 366 (12.7%) presented MRGFR by eGFRFAS and had lower age, higher BMI-SDS, BP and UA than the remaining youth reclassified as normal eGFRFAS. CONCLUSION MRGFR is associated with an altered CMR profile in a large sample of young people with overweight (OW)/obesity (OB). The eGFRFAS equation identifies a higher prevalence of youth with MRGFR, compared to eGFRBSE equation.
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Affiliation(s)
- Procolo Di Bonito
- Department of Internal Medicine, "S. Maria delle Grazie", Pozzuoli Hospital, Naples, Italy
| | - Maria Rosaria Licenziati
- Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppina Campana
- Obesity and Endocrine Disease Unit, Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudio Chiesa
- Institute of Translational Pharmacology, National Research Council, Rome, Italy
| | - Lucia Pacifico
- Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | - Melania Manco
- Research Area for Multifactorial Disease and Complex Phenotypes, Istituto di Ricovero e Cura a Carattere Scientifico Bambino Gesù Children's Hospital, Rome, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Di Sessa
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Giorgio Baroni
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences (MeSVA), University of L'Aquila, Italy; Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Giuliana Valerio
- Department of Movement Sciences and Wellbeing, University of Naples Parthenope, Naples, Italy
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Chen Y, Hodgson S, Gulliver J, Granell R, Henderson AJ, Cai Y, Hansell AL. Trimester effects of source-specific PM 10 on birth weight outcomes in the Avon Longitudinal Study of Parents and Children (ALSPAC). Environ Health 2021; 20:4. [PMID: 33413476 PMCID: PMC7788701 DOI: 10.1186/s12940-020-00684-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Evidence suggests that exposure to particulate matter with aerodynamic diameter less than 10 μm (PM10) is associated with reduced birth weight, but information is limited on the sources of PM10 and exposure misclassification from assigning exposures to place of residence at birth. METHODS Trimester and source-specific PM10 exposures (PM10 from road source, local non-road source, and total source) in pregnancy were estimated using dispersion models and a full maternal residential history for 12,020 births from the Avon longitudinal study of parents and children (ALSPAC) cohort in 1990-1992 in the Bristol area. Information on birth outcomes were obtained from birth records. Maternal sociodemographic and lifestyle factors were obtained from questionnaires. We used linear regression models for continuous outcomes (birth weight, head circumference (HC), and birth length (BL) and logistic regression models for binary outcomes (preterm birth (PTB), term low birth weight (TLBW) and small for gestational age (SGA)). Sensitivity analysis was performed using multiple imputation for missing covariate data. RESULTS After adjustment, interquartile range increases in source specific PM10 from traffic were associated with 17 to 18% increased odds of TLBW in all pregnancy periods. We also found odds of TLBW increased by 40% (OR: 1.40, 95%CI: 1.12, 1.75) and odds of SGA increased by 18% (OR: 1.18, 95%CI: 1.05, 1.32) per IQR (6.54 μg/m3) increase of total PM10 exposure in the third trimester. CONCLUSION This study adds to evidence that maternal PM10 exposures affect birth weight, with particular concern in relation to exposures to PM10 from road transport sources; results for total PM10 suggest greatest effect in the third trimester. Effect size estimates relate to exposures in the 1990s and are higher than those for recent studies - this may relate to reduced exposure misclassification through use of full residential history information, changes in air pollution toxicity over time and/or residual confounding.
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Affiliation(s)
- Yingxin Chen
- Centre for Environmental Health and Sustainability, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH UK
| | - Susan Hodgson
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - John Gulliver
- Centre for Environmental Health and Sustainability, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH UK
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Raquel Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A. John Henderson
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yutong Cai
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UK
- Deep Medicine Programme, Oxford Martin School, University of Oxford, Oxford, UK
| | - Anna L. Hansell
- Centre for Environmental Health and Sustainability, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH UK
- MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Lurbe E, Ingelfinger J. Developmental and Early Life Origins of Cardiometabolic Risk Factors: Novel Findings and Implications. Hypertension 2021; 77:308-318. [PMID: 33390043 DOI: 10.1161/hypertensionaha.120.14592] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The intent of this review is to critically consider the data that support the concept of programming and its implications. Birth weight and growth trajectories during childhood are associated with cardiometabolic disease in adult life. Both extremes, low and high birth weight coupled with postnatal growth increase the early presence of cardiometabolic risk factors and vascular imprinting, crucial elements of this framework. Data coming from epigenetics, proteomics, metabolomics, and microbiota added relevant information and contribute to better understanding of mechanisms as well as development of biomarkers helping to move forward to take actions. Research has reached a stage in which sufficiently robust data calls for new initiatives focused on early life. Prevention starting early in life is likely to have a very large impact on reducing disease incidence and its associated effects at the personal, economic, and social levels.
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Affiliation(s)
- Empar Lurbe
- From the Pediatric Department, Consorcio Hospital General, University of Valencia (E.L.)
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Spain (E.L.)
| | - Julie Ingelfinger
- Department of Pediatrics, Harvard Medical School, Mass General Hospital for Children, Massachusetts General Hospital, Boston (J.I.)
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Uemura O, Ishikura K, Kaneko T, Hirano D, Hamasaki Y, Ogura M, Mikami N, Gotoh Y, Sahashi T, Fujita N, Yamamoto M, Hibino S, Nakano M, Wakano Y, Honda M. Perinatal factors contributing to chronic kidney disease in a cohort of Japanese children with very low birth weight. Pediatr Nephrol 2021; 36:953-960. [PMID: 33068163 PMCID: PMC7910374 DOI: 10.1007/s00467-020-04791-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/22/2020] [Accepted: 09/18/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Developmental programming of chronic kidney disease (CKD) in young adults is linked to preterm birth and intrauterine growth restriction (IUGR). Which confers a higher risk of progression to chronic kidney damage in children with very low birth weight (VLBW; born weighing < 1500 g): prematurity or IUGR? METHODS This is a national historical cohort study of children with VLBW cared for in perinatal medical centers in Japan. Predictive factors included three latent variables (prematurity, IUGR, stress during neonatal period) and eight observed variables (gestational age, birth weight Z-score, maternal age, duration of treatment with antibiotics and diuretics, maternal smoking, late-onset circulatory collapse, kidney dysfunction) during the perinatal period. The primary endpoint was estimated glomerular filtration rate (eGFR) at age ≥ 3 years. A structural equation model was used to examine the pathologic constitution. RESULTS The 446 children with VLBW included 253 boys and 193 girls, of mean age 5.8 ± 2.6 years and mean eGFR 111.7 ml/min/1.73 m2 at last encounter. Pathway analyses showed intrauterine malnutrition (β = 0.85) contributed more to chronic kidney damage than stress during the neonatal period (β = - 0.19) and prematurity (β = 0.12), and kidney dysfunction and late-onset circulatory collapse were important observed variables in stress during the neonatal period. CONCLUSIONS IUGR was more harmful to future kidneys of VLBW neonates. Neonatal kidney dysfunction and late-onset circulatory collapse were important risk factors for subsequent CKD development. This emphasizes the need for obstetricians to monitor for fetal growth restriction and neonatologists to minimize neonatal stress to prevent CKD in later life.
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Affiliation(s)
- Osamu Uemura
- Department of Clinical Medicine, Japanese Red Cross Toyota College of Nursing, Toyota, Japan. .,Department of Pediatrics, Ichinomiya Medical Treatment & Habilitation Center, 1679-2 Tomida-nagaresuji, Ichinomiya-city, Aichi, 494-0018, Japan. .,Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
| | - Kenji Ishikura
- grid.63906.3a0000 0004 0377 2305Division of Nephology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan ,grid.410786.c0000 0000 9206 2938Department of Pediatrics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tetsuji Kaneko
- grid.417084.e0000 0004 1764 9914Department of Clinical Research, Tokyo Metropolitan Children’s Medical Center, Fuchu, Japan
| | - Daishi Hirano
- grid.411898.d0000 0001 0661 2073Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuko Hamasaki
- grid.265050.40000 0000 9290 9879Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Masao Ogura
- grid.63906.3a0000 0004 0377 2305Division of Nephology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Naoaki Mikami
- grid.417084.e0000 0004 1764 9914Department of Pediatric Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
| | - Yoshimitsu Gotoh
- grid.413410.3Department of Pediatric Nephrology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Takeshi Sahashi
- Department of Pediatrics, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Naoya Fujita
- Department of Pediatric Nephrology, Aichi Children’s Health and Medical Center, Nagoya, Japan
| | - Masaki Yamamoto
- grid.415466.40000 0004 0377 8408Department of Pediatrics, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Satoshi Hibino
- Department of Pediatric Nephrology, Aichi Children’s Health and Medical Center, Nagoya, Japan
| | - Masaru Nakano
- grid.417241.50000 0004 1772 7556Department of Pediatrics, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Yasuhiro Wakano
- Department of Pediatrics, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Masataka Honda
- grid.417084.e0000 0004 1764 9914Department of Pediatric Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
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Chen L, Yue J, Zhou S, Hu Y, Li J. Ouabain Protects Nephrogenesis in Rats Experiencing Intrauterine Growth Restriction and Partially Restores Renal Function in Adulthood. Reprod Sci 2021; 28:186-196. [PMID: 32767217 DOI: 10.1007/s43032-020-00280-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
Intrauterine growth restriction (IUGR) is, in general, accompanied by a reduction of the nephron number, which increases the risk of hypertension and renal dysfunction. Studies have revealed that ouabain can partially restore the number of nephrons during IUGR. However, there is limited information regarding the melioration of nephric structure and function. We used maternal malnutrition to induce an IUGR model in rats. Subsequently, we used a mini-pump to administer ouabain to IUGR rats during pregnancy. Male offspring were divided randomly into two groups. One group was fed a normal diet, whereas the other was fed an isocaloric 8% high-salt diet. Maternal malnutrition led to a reduction in the birth weight and number of nephrons in offspring. At the end of a 40-week follow-up period, offspring from the IUGR group had high blood pressure and abnormal excretion of urinary protein; these parameters were exacerbated in offspring fed a high-salt diet. However, ouabain administration during pregnancy could partially restore the number of nephrons in IUGR offspring, normalize blood pressure, and reduce urinary protein excretion, even when challenged with a high-salt diet. Pathology findings revealed that IUGR, particularly following feeding of a high-salt diet, damaged the ultrastructure of glomeruli, but these harmful effects were ameliorated in offspring treated with ouabain. Collectively, our data suggest that ouabain could rescue nephrogenesis in IUGR newborns and protect (at least in part) the structure and function of the kidney during adulthood even when encountering unfavorable environmental challenges in subsequent life.
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Affiliation(s)
- Liang Chen
- Department of Gynecology, Jiangsu Province Hospital (The First Affiliated Hospital of Nanjing Medical University), 300 Guangzhou Road, Nanjing, 210000, China.
| | - Jing Yue
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital (The Affiliated Hospital of Nanjing University Medical School), Nanjing, China
| | - Shulin Zhou
- Department of Gynecology, Jiangsu Province Hospital (The First Affiliated Hospital of Nanjing Medical University), 300 Guangzhou Road, Nanjing, 210000, China
| | - Yali Hu
- Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital (The Affiliated Hospital of Nanjing University Medical School), Nanjing, China
| | - Juan Li
- Department of Hematology, Nanjing Drum Tower Hospital (The Affiliated Hospital of Nanjing University Medical School), Nanjing, China
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Gjerde A, Lillås BS, Marti HP, Reisæter AV, Vikse BE. Intrauterine growth restriction, preterm birth and risk of end-stage renal disease during the first 50 years of life. Nephrol Dial Transplant 2020; 35:1157-1163. [PMID: 32040151 PMCID: PMC7417009 DOI: 10.1093/ndt/gfaa001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/16/2019] [Indexed: 01/24/2023] Open
Abstract
Background Low birth weight (LBW) is associated with a higher risk of end-stage renal disease (ESRD). The relative impacts of absolute birth weight, birth weight in relation to gestational age and preterm birth are, however, uncertain. Methods The Medical Birth Registry of Norway has since 1967 recorded data on all births. All patients with ESRD since 1980 have been registered in the Norwegian Renal Registry. Data from these registries were linked. All individuals registered in the Medical Birth Registry were included and the development of ESRD was used as endpoint in Cox regression statistics. LBW and LBW for gestational age [small for gestational age (SGA)] according to the 10th percentiles were used as the main predictor variables. Results Of the 2 679 967 included subjects, 1181 developed ESRD. Compared with subjects without LBW, subjects with LBW had an adjusted hazard ratio (aHR) for ESRD of 1.61 (1.38–1.98). SGA had an aHR of 1.44 (1.22– 1.70). Further analyses showed that as compared with subjects who had none of the risk factors LBW, SGA and preterm birth, subjects with one risk factor had an aHR of 1.05 (0.84–1.31), subjects with two risk factors had an aHR of 1.67 (1.40–1.98) and subjects with three risk factors had an aHR of 2.96 (1.84–4.76). Conclusions We conclude that LBW was associated with increased risk for ESRD during the first 50 years. Our analyses add to previous knowledge showing that only subjects with at least two of the risk factors LBW, SGA or preterm birth have increased risk.
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Affiliation(s)
- Anna Gjerde
- Department of Medicine, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bjørn Steinar Lillås
- Department of Medicine, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Bjørn Egil Vikse
- Department of Medicine, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Effects of Klotho supplementation on hyperoxia-induced renal injury in a rodent model of postnatal nephrogenesis. Pediatr Res 2020; 88:565-570. [PMID: 32059229 PMCID: PMC8226112 DOI: 10.1038/s41390-020-0803-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 12/18/2019] [Accepted: 02/01/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hyperoxia (HO) causes kidney injury in preterm infants; however, whether these effects are modifiable is unknown. We hypothesized that administration of exogenous soluble Klotho, a kidney-derived antioxidant, would attenuate HO-induced kidney injury during postnatal nephrogenesis in rats. METHODS Sprague Dawley neonatal rats assigned to normoxia (21% O2) or HO (85% O2) groups from postnatal day (P) 1 to 21 were randomly assigned to receive alternate day intraperitoneal injections of recombinant Klotho or placebo for 3 weeks. They were recovered in normoxia for an additional 3 weeks and sacrificed at 6 weeks. Renal artery resistance and pulsatility indices, tubular injury scores, glomerular area, and renal antioxidant capacity were assessed. RESULTS Rodents exposed to HO during postnatal nephrogenesis had reduced kidney Klotho expression, glomerulomegaly, and higher tubular injury scores. Exogenous Klotho administration improved renal perfusion as indicated by decreases in both resistance and pulsatility indices and increased antioxidant enzyme expression. CONCLUSIONS HO exposure during postnatal nephrogenesis in rodents results in a decline in kidney Klotho expression, decreased renal perfusion, enlarged glomerular size, and tubular injury. The exogenous administration of Klotho attenuated HO-induced kidney injury and augmented antioxidant capacity.
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Brennan S, Kandasamy Y, Rudd DM, Schneider ME, Jones RE, Watson DL. The effect of diabetes during pregnancy on fetal renal parenchymal growth. J Nephrol 2020; 33:1079-1089. [PMID: 32889637 DOI: 10.1007/s40620-020-00815-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS Diabetes in pregnancy is thought to adversely affect the developing fetal kidneys. The rate of gestational diabetes is increasing globally with major consequences for future renal function. Very little is known about the impact of hyperglycaemia on the fetal renal parenchyma which contains the developing nephrons. The aim of this study was to measure the fetal renal parenchymal thickness and evaluate whether diabetes during pregnancy affects the growth of the fetal kidneys. METHODS This prospective, observational study used serial ultrasound measurements to evaluate the fetal renal parenchymal growth of 55 pregnancies with diabetes compared to 72 control pregnancies. Mixed effects modelling was used to analyse the data. RESULTS The renal parenchyma of fetuses from mothers with gestational diabetes was significantly thicker than those from the control group (LR Chisq = 4.8, df = 1, p = 0.029), however, the difference was proportional to the larger size of these fetuses. Fetuses of pregestational diabetics demonstrated no significant difference in renal parenchymal thickness compared to the control group even though they were also larger fetuses. Parenchymal growth slowed with increasing abdominal circumference in the pregestational diabetic group, suggesting an adverse effect on nephrogenesis, however this did not reach statistical significance. CONCLUSIONS/INTERPRETATION Our study provides unique data on how diabetes during pregnancy influences fetal kidney growth. Appropriate management of diabetic pregnancies may mitigate some of the adverse effects on the fetal kidneys. Increasing degrees of hyperglycaemia, as seen sometimes in pregestational diabetes, may affect nephrogenesis; however larger studies are needed.
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Affiliation(s)
- Sonja Brennan
- Ultrasound Department, Townsville University Hospital, IMB 47, P.O. Box 670, Douglas, Townsville, QLD, 4810, Australia. .,Division of Tropical Health and Medicine, James Cook University, Townsville, Australia.
| | - Yogavijayan Kandasamy
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia.,Department of Neonatology, Townsville University Hospital, Townsville, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Newcastle, Australia
| | - Donna M Rudd
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Michal E Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia
| | - Rhondda E Jones
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - David L Watson
- Division of Tropical Health and Medicine, James Cook University, Townsville, Australia.,Maternal Fetal Medicine Unit and Department of Obstetrics and Gynaecology, Townsville University Hospital, Townsville, Australia
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Gjerde A, Reisæter AV, Skrunes R, Marti HP, Vikse BE. Intrauterine Growth Restriction and Risk of Diverse Forms of Kidney Disease during the First 50 Years of Life. Clin J Am Soc Nephrol 2020; 15:1413-1423. [PMID: 32816833 PMCID: PMC7536758 DOI: 10.2215/cjn.04080320] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have shown that individuals with low birth weight (LBW) or small for gestational age (SGA) have higher risk of kidney failure. This study investigates birth-related exposures and risk of CKD and other kidney diagnoses. DESIGN, SETTING, PARTICIPANT, & MEASUREMENTS The Medical Birth Registry of Norway has registered extensive medical data on all births in Norway since 1967. The Norwegian Patient Registry has registered diagnostic codes for all admissions and outpatient visits to Norwegian hospitals since 2008. Data from these registries were linked, and risk of CKD and other groups of kidney disease were analyzed using logistic regression statistics. LBW (below the tenth percentile), SGA (birth weight below the tenth percentile for gestational age), and preterm birth (<37 weeks) were analyzed as exposures. RESULTS A total of 2,663,010 individuals were included. After a mean follow-up of 26 years (maximum 50 years), 4495 had been diagnosed with CKD and 12,818 had been diagnosed with other groups of kidney disease. LBW was associated with an odds ratio (OR) for CKD of 1.72 (95% confidence interval [95% CI], 1.60 to 1.90), SGA with an OR of 1.79 (95% CI, 1.65 to 1.94), and preterm birth with an OR of 1.48 (95% CI, 1.33 to 1.66). Analyses using diagnosis of CKD at stages 3-5 as end point showed similar results. Results were similar for men and women. We analyzed adjusted ORs for other groups of kidney disease and found that LBW was associated with an adjusted OR of 1.44 (95% CI, 1.33 to 1.56) for acute kidney disease, 1.24 (95% CI, 1.14 to 1.36) for GN, 1.35 (95% CI, 1.17 to 1.56) for cystic kidney disease, and 1.15 (95% CI, 1.06 to 1.25) for kidney disease resulting from kidney or urinary tract malformations. CONCLUSIONS LBW, SGA, and preterm birth are associated with higher risk of CKD in the first 50 years of life. Risk of other groups of kidney disease was less pronounced. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_08_17_CJN04080320.mp3.
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Affiliation(s)
- Anna Gjerde
- Department of Medicine, Haugesund Hospital, Haugesund, Norway .,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Rannveig Skrunes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Egil Vikse
- Department of Medicine, Haugesund Hospital, Haugesund, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Abstract
Podocytopathies are kidney diseases in which direct or indirect podocyte injury drives proteinuria or nephrotic syndrome. In children and young adults, genetic variants in >50 podocyte-expressed genes, syndromal non-podocyte-specific genes and phenocopies with other underlying genetic abnormalities cause podocytopathies associated with steroid-resistant nephrotic syndrome or severe proteinuria. A variety of genetic variants likely contribute to disease development. Among genes with non-Mendelian inheritance, variants in APOL1 have the largest effect size. In addition to genetic variants, environmental triggers such as immune-related, infection-related, toxic and haemodynamic factors and obesity are also important causes of podocyte injury and frequently combine to cause various degrees of proteinuria in children and adults. Typical manifestations on kidney biopsy are minimal change lesions and focal segmental glomerulosclerosis lesions. Standard treatment for primary podocytopathies manifesting with focal segmental glomerulosclerosis lesions includes glucocorticoids and other immunosuppressive drugs; individuals not responding with a resolution of proteinuria have a poor renal prognosis. Renin-angiotensin system antagonists help to control proteinuria and slow the progression of fibrosis. Symptomatic management may include the use of diuretics, statins, infection prophylaxis and anticoagulation. This Primer discusses a shift in paradigm from patient stratification based on kidney biopsy findings towards personalized management based on clinical, morphological and genetic data as well as pathophysiological understanding.
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Al Salmi I, Hannawi S. Birth Weight and Susceptibility to Chronic Kidney Disease. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:717-726. [PMID: 32801232 DOI: 10.4103/1319-2442.292305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The worldwide prevalence of noncommunicable diseases (NCDs) is projected to increase substantially over the next few decades. Chronic kidney disease (CKD) is a key determinant of poor health outcomes for major NCD. Genetic predisposition and environmental exposures are contributory factors, but increasingly, it is being recognized that fetal development is also an important modulator of the NCD risk. Low birth weight (LBW) and CKD affect more disadvantaged populations and ethnic minorities and, therefore, causes a disproportionate burden on the poor. Human nephron number is highly variable and may range from under half a million to almost over two million. Significant variability is already present at birth, highlighting the importance of early nephrogenesis. Nearly 60% of nephrons are developed in the third-trimester of pregnancy. Nephron numbers increase in proportion to birth weight and gestational age. This wide-variability probably contributes to individual susceptibility to develop CKD where individuals with nephron numbers on the lower side of the spectrum are those at higher risk of developing kidney dysfunction at higher rate and progress more toward end-stage CKD. This article aims at discussing LBW and the susceptibility to CKD. Furthermore, in postnatal environment, the weight gain or change at adult life increases the metabolic demand and determines the phenotypic expression of disease along with the spectrum of nephron number. Hence, a cycle of hyperfiltration mechanism of these nephrons leads to proteinuria, glomerulo- sclerosis, and progressive development of larger glomeruli, a greater risk of proteinuria and progressive CKD. Therefore, LBW offspring are at risk of developing CKD (defined as albuminuria, a reduced glomerular filtration rate, or renal failure) in later life. Furthermore, the impact of prenatal programming is expected to be compounded with age, and the association of LBW with the risk of CKD seen in younger adults may become greater with age. It would be prudent, to adopt policies of intensified life-long surveillance of LBW people, anticipating this risk.
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Affiliation(s)
- Issa Al Salmi
- Department of Renal Medicine, The Royal Hospital; Oman Medical Specialty Board, Muscat, Oman
| | - Suad Hannawi
- Department of Rheumatology Medicine, MOHAP, Dubai, UAE
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67
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Juvet C, Siddeek B, Yzydorczyk C, Vergely C, Nardou K, Armengaud JB, Benahmed M, Simeoni U, Cachat F, Chehade H. Renal Programming by Transient Postnatal Overfeeding: The Role of Senescence Pathways. Front Physiol 2020; 11:511. [PMID: 32523548 PMCID: PMC7261937 DOI: 10.3389/fphys.2020.00511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
Background Early nutrition influences the risk of chronic kidney diseases (CKDs) development in adulthood. Mechanisms underlying the early programming of altered renal function remain incompletely understood. This study aims at characterizing the role of cell senescence pathways in early programming of CKD after transient postnatal overfeeding. Materials and Methods Reduced litters of 3 mice pups and standard litters of 9 mice pups were obtained to induce overfed animals during lactation and control animals, respectively. Animals were sacrificed at 24 days (weaning) or at 7 months of life (adulthood). Body weight, blood pressure, kidney weight, and glomerular count were assessed in both groups. Senescence pathways were investigated using β-Galactosidase staining and Western blotting of P16, P21, P53, P-Rb/Rb, and Sirtuin 1 (Sirt1) proteins. Results Early overfed animals had a higher body weight, a higher blood pressure at adulthood, and a higher glomerular number endowment compared to the control group. A higher β-Galactosidase activity, a significant increase in P53 protein expression (p = 0.0045) and a significant decrease in P-Rb/Rb ratio (p = 0.02), were observed at weaning in animals who underwent early postnatal overfeeding. Protein expression of Sirt1, a protective factor against accelerated stress-induced senescence, was significantly decreased (p = 0.03) at weaning in early overfed animals. Conclusion Early postnatal overfeeding by litter size reduction is associated with increased expression of factors involved in cellular senescence pathways, and decreased expression of Sirt 1 in the mouse kidney at weaning. These alterations may contribute to CKD programming after early postnatal overfeeding.
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Affiliation(s)
- Christian Juvet
- Division of Pediatrics, Developmental Origins of Health and Disease (DOHaD) Laboratory, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.,Division of Pediatrics, Woman-Mother-Child Department, Centre Hospitalier, Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Benazir Siddeek
- Division of Pediatrics, Developmental Origins of Health and Disease (DOHaD) Laboratory, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Catherine Yzydorczyk
- Division of Pediatrics, Developmental Origins of Health and Disease (DOHaD) Laboratory, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Catherine Vergely
- Inserm UMR866, Laboratoire de Physiopathologie et Pharmacologie Cardio-Métaboliques (LPPCM), Faculties of Medicine and Pharmacy, University of Burgundy, Dijon, France
| | - Katya Nardou
- Division of Pediatrics, Developmental Origins of Health and Disease (DOHaD) Laboratory, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Jean-Baptiste Armengaud
- Division of Pediatrics, Developmental Origins of Health and Disease (DOHaD) Laboratory, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.,Division of Pediatrics, Woman-Mother-Child Department, Centre Hospitalier, Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Mohamed Benahmed
- Division of Pediatrics, Developmental Origins of Health and Disease (DOHaD) Laboratory, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Umberto Simeoni
- Division of Pediatrics, Developmental Origins of Health and Disease (DOHaD) Laboratory, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.,Division of Pediatrics, Woman-Mother-Child Department, Centre Hospitalier, Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - François Cachat
- Division of Pediatrics, Pediatric Nephrology Unit, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Hassib Chehade
- Division of Pediatrics, Developmental Origins of Health and Disease (DOHaD) Laboratory, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.,Division of Pediatrics, Pediatric Nephrology Unit, Woman-Mother-Child Department, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Kanda T, Murai-Takeda A, Kawabe H, Itoh H. Low birth weight trends: possible impacts on the prevalences of hypertension and chronic kidney disease. Hypertens Res 2020; 43:859-868. [PMID: 32393862 DOI: 10.1038/s41440-020-0451-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 02/06/2023]
Abstract
Worldwide, hypertension and chronic kidney disease (CKD) are highly prevalent disorders and are strong risk factors for cardiovascular disease and end-stage renal disease (ESRD). The developmental origins of health and disease (DOHAD) concept suggests that undesirable perinatal environmental conditions, such as malnutrition, contribute to disease development in adults. Among the known hypertension and CKD risk factors, DOHAD plays a potential role in determining susceptibility to the onset of these diseases in later adulthood. Since low birth weight (LBW) is a surrogate marker for adverse fetal environmental conditions, the high incidence of LBW in developing countries and its increasing incidence in most developed countries (attributed to multiple pregnancies and prepregnancy maternal factors, such as undernutrition, advanced maternal age, and smoking) is concerning. Thus, LBW is an important public health problem not only because of the associated infant mortality and morbidity but also because it is a risk factor for adult-onset hypertension/CKD. During their reproductive years, pregnant women who were born with LBWs have an increased risk of hypertensive disorders of pregnancy, which contribute to the risk of developing cardiovascular disease and ESRD. The offspring of LBW females are also likely to be LBW, which suggests that susceptibility to hypertension/CKD may reflect transgenerational inheritance. Therefore, there is global concern about the increasing prevalence of LBW-related diseases. This review summarizes the relevance of hypertension and CKD in conjunction with DOHAD and discusses recent studies that have examined the impact of the upward LBW trend on renal function and blood pressure.
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Affiliation(s)
- Takeshi Kanda
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | | | | | - Hiroshi Itoh
- Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
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69
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Growth patterns and body composition in former extremely low birth weight (ELBW) neonates until adulthood: a systematic review. Eur J Pediatr 2020; 179:757-771. [PMID: 31901983 DOI: 10.1007/s00431-019-03552-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/10/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
Preterm infants are obviously born lighter and shorter, with smaller head circumferences than normal birth weight term born neonates. They also have a different body composition. Compromised growth is associated with adverse health outcomes. Both growth retardation and accelerated growth are suggested to cause metabolic, cardiovascular, and renal complications. Reviews regarding growth and body composition in preterm infants often do not differentiate between birth weight and gestational age. The purpose of this systematic review is to assemble growth data, specific in extremely low birth weight children. Different databases were searched for studies regarding growth and body composition in former extremely low birth weight infants until adulthood. We compared height, weight, head circumference, body mass index, fat mass, lean mass, fat distribution, and body water to matched normal birth weight controls and the World Health Organization growth charts. Studies consistently reported that former extremely low birth weight neonates experience a period of accelerated postnatal growth, but they achieve lower anthropometric parameters than normal birth weight children. There is no consensus about differences in body composition and how to measure this.Conclusion: Although extremely low birth weight infants exhibit a period of catch-up growth, their growth remains retarded later in life. Further research is needed to investigate body composition and the associated risk of cardiovascular diseases or metabolic syndrome.What is Known:• Extremely low birth weight infants have lower anthropometric parameters and a different body composition at birth and term-corrected age than normal birth weight infants.• Former extremely low birth weight infants also have a higher risk on adverse cardiovascular health outcomes in later life.What is New:• After hospital discharge, extremely low birth weight neonates remain smaller and probably also lighter, with smaller head circumferences at each corrected age throughout childhood and adolescence when compared to normal birth weight infants or the World Health Organization growth charts. It is not clear whether extremely low birth weight infants reach a lower or similar body mass index score as normal birth weight infants.• There is a lack of (long-term) information on body composition in extremely low birth weight infants.
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70
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Can measurement of the foetal renal parenchymal thickness with ultrasound be used as an indirect measure of nephron number? J Dev Orig Health Dis 2020; 12:184-192. [PMID: 32290891 DOI: 10.1017/s204017442000015x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic kidney disease continues to be under recognised and is associated with a significant global health burden and costs. An adverse intrauterine environment may result in a depleted nephron number and an increased risk of chronic kidney disease. Antenatal ultrasound was used to measure the foetal renal parenchymal thickness (RPT), as a novel method to estimate nephron number. Foetal renal artery blood flow was also assessed. This prospective, longitudinal study evaluated the foetal kidneys of 102 appropriately grown and 30 foetal growth-restricted foetuses between 20 and 37 weeks gestational age (GA) to provide vital knowledge on the influences foetal growth restriction has on the developing kidneys. The foetal RPT and renal artery blood flow were measured at least every 4 weeks using ultrasound. The RPT was found to be significantly thinner in growth-restricted foetuses compared to appropriately grown foetuses [likelihood ratio (LR) = 21.06, P ≤ 0.0001] and the difference increases with GA. In foetuses with the same head circumference, a growth-restricted foetus was more likely to have a thinner parenchyma than an appropriately grown foetus (LR = 8.9, P = 0.0028), supporting the principle that growth-restricted foetuses preferentially shunt blood towards the brain. No significant difference was seen in the renal arteries between appropriately grown and growth-restricted foetuses. Measurement of the RPT appears to be a more sensitive measure than current methods. It has the potential to identify infants with a possible reduced nephron endowment allowing for monitoring and interventions to be focused on individuals at a higher risk of developing future hypertension and chronic kidney disease.
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71
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Goetschalckx E, Mekahli D, Levtchenko E, Allegaert K. Glomerular Filtration Rate in Former Extreme Low Birth Weight Infants over the Full Pediatric Age Range: A Pooled Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17062144. [PMID: 32213814 PMCID: PMC7142917 DOI: 10.3390/ijerph17062144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/20/2020] [Indexed: 12/21/2022]
Abstract
Various cohort studies document a lower glomerular filtration rate (GFR) in former extremely low birth weight (ELBW, <1000 g) neonates throughout childhood when compared to term controls. The current aim is to pool these studies to describe the GFR pattern over the pediatric age range. To do so, we conducted a systematic review on studies reporting on GFR measurements in former ELBW cases while GFR data of healthy age-matched controls included in these studies were co-collected. Based on 248 hits, 6 case-control and 3 cohort studies were identified, with 444 GFR measurements in 380 former ELBW cases (median age 5.3–20.7 years). The majority were small (17–78 cases) single center studies, with heterogeneity in GFR measurement (inulin, cystatin C or creatinine estimated GFR formulae) tools. Despite this, the median GFR (mL/min/1.73 m2) within case-control studies was consistently lower (−13%, range −8% to −25%) in cases, so that a relevant minority (15–30%) has a eGFR<90 mL/min/1.73 m2). Consequently, this pooled analysis describes a consistent pattern of reduced eGFR in former ELBW cases throughout childhood. Research should focus on perinatal risk factors for impaired GFR and long-term outcome, but is hampered by single center cohorts, study size and heterogeneity of GFR assessment tools.
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Affiliation(s)
- Elise Goetschalckx
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; (E.G.); (D.M.); (E.L.)
| | - Djalila Mekahli
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; (E.G.); (D.M.); (E.L.)
- Department of Pediatric Nephrology and Organ Transplantation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Elena Levtchenko
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; (E.G.); (D.M.); (E.L.)
- Department of Pediatric Nephrology and Organ Transplantation, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; (E.G.); (D.M.); (E.L.)
- Department of Pharmacy and Pharmaceutical Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Department of Clinical Pharmacy, Wytemaweg Hospital Pharmacy Postbus 2040, Erasmus MC, Rotterdam, The Netherlands
- Correspondence:
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72
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Renal functional markers in extremely premature infants with and without twin-twin transfusion syndrome. J Perinatol 2020; 40:256-262. [PMID: 31616050 DOI: 10.1038/s41372-019-0524-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/25/2019] [Accepted: 09/27/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Describe renal function of preterm infants <29 weeks of gestational age (GA) with twin-twin transfusion syndrome (TTTS) who received laser therapy. DESIGN Retrospective analysis of premature TTTS compared with dichorionic-diamniotic (di-di) twins from 2006 to 2015. Primary outcome was biomarkers of renal injury. RESULTS Thirty-three TTTS-laser and 101 di-di newborns with similar GA at birth (26.4 ± 1.4 vs 26.9 ± 1.6 weeks, p = 0.07) were included. Creatinine and urea levels were higher in TTTS-laser group at day of life (DOL) 2-7 (123.5 ± 12.4 vs 75.8 ± 2 μmol/L, p = 0.0001 and 11.9 ± 1.1 mmol/L vs 8.7 ± 0.3 mmol/L, p = 0.0001) and DOL 8-14, (98.1 ± 14.2 vs 64.8 ± 2.3 μmol/L, p = 0.0001 and 9.1 ± 1.2 vs 5.4 ± 0.3 mmol/L, p = 0.0001). There was a significant effect of TTTS status on creatinine level at DOL 8-14. CONCLUSION In extremely preterm with TTTS treated by laser, biomarkers of renal function were higher compared with di-di twins in the first 2 weeks of life.
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73
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Liang X, Xiao L, Luo Y, Xu J. Prevalence and Risk Factors of Childhood Hypertension in Urban-Rural Areas of China: A Cross-Sectional Study. Int J Hypertens 2020; 2020:2374231. [PMID: 32454994 PMCID: PMC7240786 DOI: 10.1155/2020/2374231] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The increased blood pressure level in children and adolescents is recognized as an essential predictor of adulthood cardiovascular disease. This study aimed to ascertain the prevalence and the urban-rural disparity of childhood hypertension in the southwest of China. METHODS Using stratified cluster sampling in urban and rural areas, a total of 13597 primary school children aged 6∼12 years living in the Southwest of China were included. The prevalence of hypertension was analyzed. The risk factors were collected by questionnaires, and the risk factors of childhood hypertension were analyzed by the logistic regression model. RESULTS The prevalence of hypertension was 13.75%, 9.02%, and 17.47% in total, urban, and rural children, respectively, and the urban-rural difference was 8.44% (95%CI: 7.32%, 9.56%). Children with obesity, maternal gestational hypertension, >10 months of breastfeeding, or low family income had a significantly increased prevalence of hypertension (29.4%, 20.00%, 16.31%, and 16.25%, respectively). Rural residence, intake of more pickle (in rural), maternal gestational hypertension (in urban), low birth weight (in rural), obesity, increased heart rate, and red blood cell counts were the risk factors of childhood hypertension. The adjusted R 2 values were 13.61%, 23.25%, 10.88%, 11.12%, 12.23%, and 25.04% in the full models excluding and including serum indexes for total, urban, and rural children, respectively. CONCLUSIONS The prevalence of childhood hypertension is significant in the Southwest of China and alarming in rural areas, which requires community intervention. Children living in rural areas combined with obesity, low social economic status, dietary imbalance, and abnormal lipid metabolism were associated with an increased risk of hypertension, and routine care programs should be conducted to prevent childhood hypertension.
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Affiliation(s)
- Xiaohua Liang
- 1Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Lun Xiao
- 2Disease Control and Prevention Center of Jiulongpo District, Chongqing, China
| | - Yetao Luo
- 1Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
| | - Jiapei Xu
- 1Clinical Epidemiology and Biostatistics Department, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, China International Science and Technology Cooperation Center of Child Development and Critical Disorders, Chongqing, China
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74
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Allegaert K, Smits A, van Donge T, van den Anker J, Sarafidis K, Levtchenko E, Mekahli D. Renal Precision Medicine in Neonates and Acute Kidney Injury: How to Convert a Cloud of Creatinine Observations to Support Clinical Decisions. Front Pediatr 2020; 8:366. [PMID: 32850523 PMCID: PMC7399072 DOI: 10.3389/fped.2020.00366] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/02/2020] [Indexed: 12/29/2022] Open
Abstract
Renal precision medicine in neonates is useful to support decision making on pharmacotherapy, signal detection of adverse (drug) events, and individual prediction of short- and long-term prognosis. To estimate kidney function or glomerular filtration rate (GFR), the most commonly measured and readily accessible biomarker is serum creatinine (Scr). However, there is extensive variability in Scr observations and GFR estimates within the neonatal population, because of developmental physiology and superimposed pathology. Furthermore, assay related differences still matter for Scr, but also exist for Cystatin C. Observations in extreme low birth weight (ELBW) and term asphyxiated neonates will illustrate how renal precision medicine contributes to neonatal precision medicine. When the Kidney Disease Improving Global Outcome (KDIGO) definition of acute kidney injury (AKI) is used, this results in an incidence up to 50% in ELBW neonates, associated with increased mortality and morbidity. However, urine output criteria needed adaptations to broader time intervals or weight trends, while Scr and its trends do not provide sufficient detail on kidney function between ELBW neonates. Instead, we suggest to use assay-specific centile Scr values to better describe postnatal trends and have illustrated its relevance by quantifying an adverse drug event (ibuprofen) and by explaining individual amikacin clearance. Term asphyxiated neonates also commonly display AKI. While oliguria is a specific AKI indicator, the majority of term asphyxiated cases are non-oliguric. Asphyxia results in a clinical significant-commonly transient-mean GFR decrease (-50%) with a lower renal drug elimination. But there is still major (unexplained) inter-individual variability in GFR and subsequent renal drug elimination between these asphyxiated neonates. Recently, the Baby-NINJA (nephrotoxic injury negated by just-in-time action) study provided evidence on the concept that a focus on nephrotoxic injury negation has a significant impact on AKI incidence and severity. It is hereby important to realize that follow-up should not be discontinued at discharge, as there are concerns about long-term renal outcome. These illustrations suggest that integration of renal (patho)physiology into neonatal precision medicine are an important tool to improve contemporary neonatal care, not only for the short-term but also with a positive health impact throughout life.
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Affiliation(s)
- Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pharmacy and Pharmaceutical Sciences, KU Leuven, Leuven, Belgium.,Department of Clinical Pharmacy, Erasmus MC, Rotterdam, Netherlands
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Tamara van Donge
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | - John van den Anker
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital (UKBB), University of Basel, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Hospital, Washington, DC, United States.,Intensive Care and Department of Pediatric Surgery, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - Kosmas Sarafidis
- First Department of Neonatology, School of Medicine, Aristotle University of Thessaloniki, Hippokrateion General Hospital, Thessaloniki, Greece
| | - Elena Levtchenko
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatric Nephrology and Organ Transplantation, Hospitals Leuven, Leuven, Belgium
| | - Djalila Mekahli
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Pediatric Nephrology and Organ Transplantation, Hospitals Leuven, Leuven, Belgium
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75
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Ordóñez-Díaz MD, Pérez-Navero JL, Flores-Rojas K, Olza-Meneses J, Muñoz-Villanueva MC, Aguilera-García CM, Gil-Campos M. Prematurity With Extrauterine Growth Restriction Increases the Risk of Higher Levels of Glucose, Low-Grade of Inflammation and Hypertension in Prepubertal Children. Front Pediatr 2020; 8:180. [PMID: 32373566 PMCID: PMC7186313 DOI: 10.3389/fped.2020.00180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/30/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: An adipose tissue programming mechanism could be implicated in the extrauterine growth restriction (EUGR) of very preterm infants with morbidity in the cardiometabolic status later in life, as has been reported in intrauterine growth restriction. The aim of this study was to assess whether children with a history of prematurity and EUGR, but also with an adequate growth, showed alterations in the metabolic and inflammatory status. Methods: This was a case-control study. A total of 88 prepubertal children with prematurity antecedents were selected: 38 with EUGR and 50 with an adequate growth pattern (PREM group). They were compared with 123 healthy children born at term. Anthropometry, metabolic parameters, blood pressure (BP), C-reactive protein, hepatocyte growth factor (HGF), interleukin-6 (IL-6), IL-8, monocyte chemotactic protein type 1 (MCP-1), neural growth factor, tumour necrosis factor-alpha (TNF-α) and plasminogen activator inhibitor type-1 were analysed at the prepubertal age. Results: EUGR children exhibited higher BP levels and a higher prevalence of hypertension (46%) compared with both PREM (10%) and control (2.5%) groups. Moreover, there was a positive relationship between BP levels and values for glucose, insulin and HOMA-IR only in children with a EUGR history. The EUGR group showed higher concentrations of most of the cytokines analysed, markedly higher TNF-α, HGF and MCP-1 levels compared with the other two groups. Conclusion: EUGR status leads to cardiometabolic changes and a low-grade inflammatory status in children with a history of prematurity, and that could be related with cardiovascular risk later in life.
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Affiliation(s)
- Maria D Ordóñez-Díaz
- Department of Paediatrics, Maimónides Biomedical Research Institute, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | - Juan L Pérez-Navero
- Department of Paediatrics, Maimónides Biomedical Research Institute, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain.,Centre for Biomedical Research on Rare Diseases (CIBERER-ISCIII), Madrid, Spain
| | - Katherine Flores-Rojas
- Unit of Metabolism and Paediatric Research, Maimónides Biomedical Research Institute, Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
| | - Josune Olza-Meneses
- Laboratory 123, Department of Biochemistry and Molecular Biology II, Centre of Biomedical Research, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Maria C Muñoz-Villanueva
- Unit of Methodological Support to Research, Maimónides Biomedical Research Institute, Córdoba, Spain
| | - Concepción M Aguilera-García
- Laboratory 123, Department of Biochemistry and Molecular Biology II, Centre of Biomedical Research, Institute of Nutrition and Food Technology, University of Granada, Granada, Spain
| | - Mercedes Gil-Campos
- Unit of Metabolism and Paediatric Research, Maimónides Biomedical Research Institute, Reina Sofia University Hospital, University of Córdoba, Córdoba, Spain
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Robinson AT, Cook MD, Lane-Cordova AD. Making cell culture more physiological: a call for a more comprehensive assessment of racial disparities in endothelial cell culture studies. Am J Physiol Cell Physiol 2019; 318:C238-C241. [PMID: 31747315 DOI: 10.1152/ajpcell.00467.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In the United States, cardiovascular diseases (CVDs) are the leading cause of death and disproportionately affect ethnic and racial minority populations. Black individuals are more likely to develop advanced CVD and microvascular complications resulting in end-organ damage. Endothelial cell dysfunction leads to microvascular and macrovascular dysfunction and is predictive of the development of CVD. Black versus white racial disparities in in vivo and in vitro studies of endothelial cell function are well documented. However, race-related disparities in maternal environment and lifestyle may be a major unconsidered factor in racial differences in endothelial cell culture studies. Further, rates of hypertensive disorders of pregnancy are higher in black versus white women. These pregnancy complications may result in placental dysfunction, including excess production of inflammatory and antiangiogenic molecules that impair endothelial function. Therefore, studies that include other ethnic and racial minorities are needed, in addition to a more thorough characterization of endothelial cell donors and targeted cell culture studies (e.g., genotyping) to generate information that can be translated into effective preventive or treatment strategies for ethnic/racial disparities in CVD.
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Affiliation(s)
- Austin T Robinson
- School of Kinesiology, Neurovascular Physiology Laboratory, Auburn University, Auburn, Alabama
| | - Marc D Cook
- Department of Kinesiology, North Carolina Agriculture and Technology State University, Greensboro, North Carolina
| | - Abbi D Lane-Cordova
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina at Columbia, Columbia, South Carolina
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77
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Kanzaki G, Tsuboi N, Shimizu A, Yokoo T. Human nephron number, hypertension, and renal pathology. Anat Rec (Hoboken) 2019; 303:2537-2543. [PMID: 31729838 DOI: 10.1002/ar.24302] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/12/2022]
Abstract
Recent studies have reported that total nephron number varies widely in human kidneys and some racial groups with low nephron number have a higher incidence of hypertension and kidney disease. Importantly, nephrogenesis normally reaches completion at about 34-36 weeks gestation, with no new nephrons formed for the lifetime in humans after this time. Although the loss of glomeruli varies among individuals due to aging, blood pressure, or additional inducers of kidney injury, much of the variation in nephron number is nowadays thought to be present at birth. According to the hyperfiltration hypothesis, this subsequent nephron loss results in compensatory hyperfiltration and/or hypertension of remaining glomeruli, thereby contributing to increased susceptibility to systemic hypertension. However, recent studies have suggested that the association between a low nephron number and systemic hypertension is not a universal finding. In most studies to date, nephron counts were performed on kidneys obtained at autopsy. Several recent studies have attempted to estimate nephron number in living human subjects, but further work is required to obtain accurate and precise estimates of nephron number using these noninvasive methods. Longitudinal studies in living humans have the potential to reveal associations between nephron number and hypertension/renal pathology.
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Affiliation(s)
- Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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78
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Intapad S, Dasinger JH, Johnson JM, Brown AD, Ojeda NB, Alexander BT. Male and Female Intrauterine Growth-Restricted Offspring Differ in Blood Pressure, Renal Function, and Glucose Homeostasis Responses to a Postnatal Diet High in Fat and Sugar. Hypertension 2019; 73:620-629. [PMID: 30636548 DOI: 10.1161/hypertensionaha.118.12134] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
It is well established that inadequate nutrition during fetal life followed by postnatal overabundance programs adiposity and glucose intolerance. Studies addressing sexual dimorphism in developmental responses to a dietary mismatch are limited; the effect on blood pressure and renal function is understudied. Therefore, this study tested the hypothesis that a mismatch of prenatal and postnatal nutrition heightens cardiorenal and metabolic risk, outcomes that may vary by sex. Male and female offspring from sham-operated (control) or reduced uterine perfusion dams (growth restricted) were fed regular chow or a diet high in fat and sugar (enriched diet) from weaning until 6 months of age. Male and female offspring were assessed separately; 2-way ANOVA was used to investigate interactions between intrauterine growth-restricted and enriched-diet. Blood pressure was increased in all enriched-diet groups but did not differ in enriched-diet male or female growth-restricted versus same-sex control counterparts. Glomerular filtration rate was reduced in male growth-restricted regardless of diet; a decrease exacerbated by the enriched-diet suggesting the pathogenesis of increased blood pressure induced via an enriched-diet differs between male growth-restricted versus male control. An enriched diet was associated with glucose intolerance in male and female control but not male growth-restricted; the enriched diet exacerbated glucose intolerance in female growth-restricted. Thus, these findings indicate male growth-restricted are resistant to impaired glucose homeostasis, whereas female growth-restricted are susceptible to metabolic dysfunction regardless of postnatal diet. Hence, moderation of fat and sugar intake may be warranted in those born low birth weight to ensure minimal risk for chronic disease.
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Affiliation(s)
- Suttira Intapad
- From the Department of Physiology and Biophysics (S.I., J.H.D., J.M.J., A.D.B., B.T.A.), University of Mississippi Medical Center, Jackson.,Department of Pharmacology, Tulane University School of Medicine, New Orleans, LA (S.I.)
| | - John Henry Dasinger
- From the Department of Physiology and Biophysics (S.I., J.H.D., J.M.J., A.D.B., B.T.A.), University of Mississippi Medical Center, Jackson
| | - Jeremy M Johnson
- From the Department of Physiology and Biophysics (S.I., J.H.D., J.M.J., A.D.B., B.T.A.), University of Mississippi Medical Center, Jackson
| | - Andrew D Brown
- From the Department of Physiology and Biophysics (S.I., J.H.D., J.M.J., A.D.B., B.T.A.), University of Mississippi Medical Center, Jackson
| | - Norma B Ojeda
- Department of Pediatrics (N.B.O.), University of Mississippi Medical Center, Jackson
| | - Barbara T Alexander
- From the Department of Physiology and Biophysics (S.I., J.H.D., J.M.J., A.D.B., B.T.A.), University of Mississippi Medical Center, Jackson
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79
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Luyckx VA, Brenner BM. Clinical consequences of developmental programming of low nephron number. Anat Rec (Hoboken) 2019; 303:2613-2631. [PMID: 31587509 DOI: 10.1002/ar.24270] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/30/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
Nephron number in humans varies up to 13-fold, likely reflecting the impact of multiple factors on kidney development, including inherited body size and ethnicity, as well as maternal health and nutrition, fetal exposure to gestational diabetes or preeclampsia and other environmental factors, which may potentially be modifiable. Such conditions predispose to low or high offspring birth weight, growth restriction or preterm birth, which have all been associated with increased risks of higher blood pressures and/or kidney dysfunction in later life. Low birth weight, preterm birth, and intrauterine growth restriction are associated with reduced nephron numbers. Humans with hypertension and chronic kidney disease tend to have fewer nephrons than their counterparts with normal blood pressures or kidney function. A developmentally programmed reduction in nephron number therefore enhances an individual's susceptibility to hypertension and kidney disease in later life. A low nephron number at birth may not lead to kidney dysfunction alone except when severe, but in the face of superimposed acute or chronic kidney injury, a kidney endowed with fewer nephrons may be less able to adapt, and overt kidney disease may develop. Given that millions of babies are born either too small, too big or too soon each year, the population impact of altered renal programming is likely to be significant. Many gestational exposures are modifiable, therefore urgent attention is required to implement public health measures to optimize maternal, fetal, and child health, to prevent or mitigate the consequences of developmental programming, to improve the health future generations.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Switzerland
| | - Barry M Brenner
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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80
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Bahizire E, Dramaix M, Bigirinama R, Balegamire S, Balungu Y, Meuris S, D'Alessandro U, Donnen P. Prevention against malaria before the first antenatal visit and absence of anaemia at the first visit were protective from low birth weight: results from a South Kivu cohort, Democratic Republic of the Congo. Trans R Soc Trop Med Hyg 2019; 112:383-392. [PMID: 30053261 DOI: 10.1093/trstmh/try066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 06/15/2018] [Indexed: 11/12/2022] Open
Abstract
Background There is little information on the causes of low birth weight (LBW, <2500 g) in South Kivu. The authors determined the prevalence of LBW among full-term newborns, and its relationship with malaria and anaemia at the first antenatal visit (ANV1) in the rural health zone of Miti-Murhesa, in the eastern Democratic Republic of the Congo. Methods Four-hundred-and-seventy-eight pregnant women in the second trimester attending their first antenatal clinic were recruited between November 2010 and July 2011, and followed-up until delivery. Besides information on use of preventive measures and malaria morbidity, anthropometric measures and a blood sample were collected. Results Women's mean age (SD) at enrolment, was 26 (6.5) years (n=434); prevalence of malaria was 9.5% (43/453) and that of anaemia 32.2% (141/439). The latter was significantly more frequent in malaria-infected women and in those who had not been dewormed. At delivery, prevalence of LBW was 6.5% (23/355) and was independently associated with not sleeping under insecticide-treated bed net (p=0.030), mother's height <150 cm (p=0.001) and anaemia at the ANV1 (p=0.006). Conclusion In South Kivu, malaria and anaemia are important risk factors for LBW, and should be prevented among all women of reproductive age.
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Affiliation(s)
- Esto Bahizire
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Route de Lennik, 808, CP 594, Brussels, Belgium.,Department of Medical Microbiology, University of Nairobi, KNH CAMPUS, Nairobi-00202, Kenya.,Centre de Recherche en Sciences Naturelles de Lwiro, 343 Av. PE Lumumba, Bukavu
| | - Michèle Dramaix
- Center of Research in Epidemiology, Biostatistics and Clinical Research, Université Libre de Bruxelles, Route de Lennik, 808, CP 594, Brussels, Belgium
| | - Rosine Bigirinama
- Department of Paediatrics, Université Catholique de Bukavu, 2 Av. Michombero, Bukavu, Democratic Republic of the Congo
| | - Safari Balegamire
- Centre de Recherche en Sciences Naturelles de Lwiro, 343 Av. PE Lumumba, Bukavu.,Department of Community Health, Université de Montréal, 7101 Av du Parc, Montréal (Quebec) H3N 1X9, Canada
| | - Yves Balungu
- Department of Gynaecology and Obstetrics, Université Catholique de Bukavu, 2 Av. Michombero, Bukavu, Democratic Republic of the Congo
| | - Sylvain Meuris
- Laboratory of experimental hormonology, Université Libre de Bruxelles, Route de Lennik, 808, CP 594, 1070 Brussels, Belgium
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia, Fajara, Atlantic Boulevard, Fajara, Banjul, The Gambia.,London School of Hygiene and Tropical Medicine, Keppel Street London WC1E 7HT, United Kingdom
| | - Philippe Donnen
- Center of Research in Health Policy and Systems-International Health, Université Libre de Bruxelles, Route de Lennik, 808, CP 594, Brussels, Belgium
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Gilarska M, Raaijmakers A, Zhang ZY, Staessen JA, Levtchenko E, Klimek M, Grudzień A, Starzec K, Allegaert K, Kwinta P. Extremely Low Birth Weight Predisposes to Impaired Renal Health: A Pooled Analysis. Kidney Blood Press Res 2019; 44:897-906. [PMID: 31536985 DOI: 10.1159/000502715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A number of studies examined the association between preterm delivery and kidney size and function later in life. However, the number of cases in published cohort studies is low. This study was aimed at performing a multicenter collaboration to pool data to obtain more accurate results to quantify the extent of renal impairment in former extremely low birth weight (ELBW; <1,000 g) children. METHODOLOGY We performed a subject-level meta-analysis to pool data from Cracow (64 cases/34 controls) and Leuven (93 cases/87 controls). We assessed and analyzed cystatin C, estimated glomerular filtration rate (eGFR), ultrasound kidney length, and blood pressure (BP) in 11-year-old ELBW children compared with controls born at term. The prevalence of hypertension (HT) and prehypertension (preHT) in both groups was also analyzed. RESULTS The study group comprised 157 former ELBW children (gestational age 23-33 weeks and birth weight 430-1,000 g) and 123 children born at term. Former ELBW children had lower mean eGFR (100.62 ± 16.53 vs. 111.89 ± 15.26 mL/min/1.73 m2; p < 0.001), smaller absolute kidney length (8.56 ± 0.78 vs. 9.008 ± 0.73 cm; <0.001), and higher systolic (111.8 ± 9.8 vs. 107.2 ± 9.07 mm Hg; p = 0.01) and diastolic (68.6 ± 6.8 vs. 66.3 ± 7.7 mm Hg; p = 0.03) BP. Smaller renal size in former ELBW children was positively associated with lower birth weight, shorter gestational age, and severity of perinatal complications (intraventricular hemorrhage, length of stay, mechanical ventilation, and oxygen therapy). CONCLUSION ELBW is associated with lower eGFR and a high frequency of preHT and HT.
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Affiliation(s)
- Maja Gilarska
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Anke Raaijmakers
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium.,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Department of Cardiovascular Sciences, Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Department of Cardiovascular Sciences, Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven, Leuven, Belgium
| | - Elena Levtchenko
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium.,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Małgorzata Klimek
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Andrzej Grudzień
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Starzec
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Karel Allegaert
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium.,Intensive Care and Department of Pediatric Surgery and Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland,
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82
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Ahmed SB, Dumanski SM. Why Do Patients With Well-Controlled Vascular Risk Factors Develop Progressive Chronic Kidney Disease? Can J Cardiol 2019; 35:1170-1180. [DOI: 10.1016/j.cjca.2019.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 01/17/2023] Open
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83
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Perico N, Askenazi D, Cortinovis M, Remuzzi G. Maternal and environmental risk factors for neonatal AKI and its long-term consequences. Nat Rev Nephrol 2019; 14:688-703. [PMID: 30224767 DOI: 10.1038/s41581-018-0054-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acute kidney injury (AKI) is a common and life-threatening complication in critically ill neonates. Gestational risk factors for AKI include premature birth, intrauterine growth restriction and low birthweight, which are associated with poor nephron development and are often the consequence of pre-gestational and gestational factors, such as poor nutritional status. Our understanding of how to best optimize renal development and prevent AKI is in its infancy; however, the identification of pre-gestational and gestational factors that increase the risk of adverse neonatal outcomes and the implementation of interventions, such as improving nutritional status early in pregnancy, have the potential to optimize fetal growth and reduce the risk of preterm birth, thereby improving kidney health. The overall risk of AKI among critically ill and premature neonates is exacerbated postnatally as these infants are often exposed to dehydration, septic shock and potentially nephrotoxic medications. Strategies to improve outcomes - for example, through careful evaluation of nephrotoxic drugs - may reduce the incidence of AKI and its consequences among this population. Management strategies and updated technology that will support neonates with AKI are greatly needed. Extremely premature infants and those who survive an episode of AKI should be screened for chronic kidney disease until early adulthood. Here, we provide an overview of our current understanding of neonatal AKI, focusing on its relationship to preterm birth and growth restriction. We describe factors that prevent optimal nephrogenesis during pregnancy and provide a framework for future explorations designed to maximize outcomes in this vulnerable population.
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Affiliation(s)
- Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - David Askenazi
- Pediatric and Infant Center for Acute Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica Cortinovis
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy. .,Unit of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy. .,L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
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84
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Postnatal podocyte gain: Is the jury still out? Semin Cell Dev Biol 2019; 91:147-152. [DOI: 10.1016/j.semcdb.2018.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/24/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
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85
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Chi C, Xue Y, Liu R, Wang Y, Lv N, Zeng H, Buys N, Zhu B, Sun J, Yin C. Effects of a formula with a probiotic Bifidobacterium lactis Supplement on the gut microbiota of low birth weight infants. Eur J Nutr 2019; 59:1493-1503. [PMID: 31197506 DOI: 10.1007/s00394-019-02006-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Low birth weight (LBW) infants have a less diverse gut microbiota, enriched in potential pathogens, which places them at high risk of systemic inflammation diseases. This study aimed to identify the differences in gut bacterial community structure between LBW infants who received probiotics and LBW infants who did not receive probiotics. METHODS Forty-one infants were allocated to the non-probiotic group (N group) and 56 infants to the probiotic group (P group), according to whether the formula they received contained a probiotic Bifidobacterium lactis. Gut bacterial composition was identified with sequencing of the 16S rRNA gene in fecal samples collected at 14 days after birth. RESULTS There was no significant difference between the alpha diversity of the two groups, while the beta diversity was significantly different (p < 0.05). Our results showed that Bifidobacterium and Lactobacillus (both p < 0.05) were enriched in the P group, while Veillonella, Dolosigranulum and Clostridium sensu stricto 1 (all p < 0.05) were enriched in the N group. Predicted metagenome function analysis revealed enhancement of fatty acids, peroxisome, starch, alanine, tyrosine and peroxisome pathways in the P group, and enhancement of plant pathogen, Salmonella and Helicobacter pylori infection pathways in the N group. CONCLUSIONS Probiotic supplement in formula may affect the composition, stability and function of LBW infants' gut microbiota. LBW infants who receive probiotic intervention may benefit from gut microbiota that contains more beneficial bacteria.
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Affiliation(s)
- Cheng Chi
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Yong Xue
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China
| | - Ruixia Liu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Yanxin Wang
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Na Lv
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Science, Beijing, 100101, China
| | - Huihui Zeng
- Department of Neonatology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Nicholas Buys
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Baoli Zhu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Science, Beijing, 100101, China.
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast, QLD, 4222, Australia.
| | - Chenghong Yin
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China.
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86
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Affiliation(s)
- Giorgina Barbara Piccoli
- Nephrology, Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
- Nephrologie, Centre Hospitalier Le Mans, Le Mans, France
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87
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Chi C, Xue Y, Lv N, Hao Y, Liu R, Wang Y, Ding X, Zeng H, Li G, Shen Q, Hu X, Chen L, Jiang T, Zhao J, Buys N, Sun J, Yin C, Zhu B. Longitudinal Gut Bacterial Colonization and Its Influencing Factors of Low Birth Weight Infants During the First 3 Months of Life. Front Microbiol 2019; 10:1105. [PMID: 31156608 PMCID: PMC6529567 DOI: 10.3389/fmicb.2019.01105] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/30/2019] [Indexed: 12/03/2022] Open
Abstract
Establishment of low birth weight (LBW) infant gut microbiota may have lifelong implications for the health of individuals. However, no longitudinal cohort studies have been conducted to characterize the gut microbial profiles of LBW infants and their influencing factors. Our objective was to understand how the gut bacterial community structure of LBW and normal birth weight (NBW) infants varies across the first 3 months of life and assess the influencing factors. In this observational cohort study, gut bacterial composition was identified with sequencing of the 16S rRNA gene in fecal samples of 69 LBW infants and 65 NBW controls at 0 day, 3 days, 2 weeks, 6 weeks, and 3 months (defined as stages 1–5) after birth. Alpha-diversity of both groups displayed a decreasing trend followed by slight variations. There were significant differences on the Shannon index of the two groups at stages 1 to 3 (P = 0.041, P = 0.032, and P = 0.014, respectively). The microbiota community structure of LBW infants were significantly different from NBW infants throughout the 3 months (all P < 0.05) but not at stage 2 (P = 0.054). There was a significant increase in abundance in Firmicutes while a decrease in Proteobacteria, and at genus level the abundance of Enterococcus, Klebsiella, and Streptococcus increased while it decreased for Haemophilus in LBW group. Birth weight was the main factor explaining the observed variation at all stages, except at stage 2. Delivery mode (4.78%) and antibiotic usage (3.50%) contributed to explain the observed variation at stage 3, and pregestational BMI (4.61%) partially explained the observed variation at stage 4. In conclusion, gut microbial communities differed in NBW and LBW infants from birth to 3 months of life, and were affected by birth weight, delivery mode, antibiotic treatment, and pregestational BMI.
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Affiliation(s)
- Cheng Chi
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yong Xue
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China.,CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Na Lv
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Yanan Hao
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Ruixia Liu
- Department of Central Laboratory, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yanxin Wang
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xin Ding
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Huihui Zeng
- Department of Neonatology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Geng Li
- Department of Neonatology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Qun Shen
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Xiaosong Hu
- College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China
| | - Lijun Chen
- National Engineering Center of Dairy for Early Life Health, Beijing Sanyuan Foods Co., Ltd., Beijing, China
| | - Tiemin Jiang
- National Engineering Center of Dairy for Early Life Health, Beijing Sanyuan Foods Co., Ltd., Beijing, China
| | - Junying Zhao
- National Engineering Center of Dairy for Early Life Health, Beijing Sanyuan Foods Co., Ltd., Beijing, China
| | - Nicholas Buys
- School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Jing Sun
- School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Chenghong Yin
- Department of Internal Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Baoli Zhu
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.,Beijing Key Laboratory of Microbial Drug Resistance and Resistome, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Pathogenic Biology, School of Basic Medical Sciences, Southwest Medical University, Chengdu, China
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88
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Crump C, Sundquist J, Winkleby MA, Sundquist K. Preterm birth and risk of chronic kidney disease from childhood into mid-adulthood: national cohort study. BMJ 2019; 365:l1346. [PMID: 31043374 PMCID: PMC6490674 DOI: 10.1136/bmj.l1346] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the relation between preterm birth (gestational age <37 weeks) and risk of CKD from childhood into mid-adulthood. DESIGN National cohort study. SETTING Sweden. PARTICIPANTS 4 186 615 singleton live births in Sweden during 1973-2014. EXPOSURES Gestational age at birth, identified from nationwide birth records in the Swedish birth registry. MAIN OUTCOME MEASURES CKD, identified from nationwide inpatient and outpatient diagnoses through 2015 (maximum age 43 years). Cox regression was used to examine gestational age at birth and risk of CKD while adjusting for potential confounders, and co-sibling analyses assessed the influence of unmeasured shared familial (genetic or environmental) factors. RESULTS 4305 (0.1%) participants had a diagnosis of CKD during 87.0 million person years of follow-up. Preterm birth and extremely preterm birth (<28 weeks) were associated with nearly twofold and threefold risks of CKD, respectively, from birth into mid-adulthood (adjusted hazard ratio 1.94, 95% confidence interval 1.74 to 2.16; P<0.001; 3.01, 1.67 to 5.45; P<0.001). An increased risk was observed even among those born at early term (37-38 weeks) (1.30, 1.20 to 1.40; P<0.001). The association between preterm birth and CKD was strongest at ages 0-9 years (5.09, 4.11 to 6.31; P<0.001), then weakened but remained increased at ages 10-19 years (1.97, 1.57 to 2.49; P<0.001) and 20-43 years (1.34, 1.15 to 1.57; P<0.001). These associations affected both males and females and did not seem to be related to shared genetic or environmental factors in families. CONCLUSIONS Preterm and early term birth are strong risk factors for the development of CKD from childhood into mid-adulthood. People born prematurely need long term follow-up for monitoring and preventive actions to preserve renal function across the life course.
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Affiliation(s)
- Casey Crump
- Icahn School of Medicine at Mount Sinai, Departments of Family Medicine and Community Health and of Population Health Science and Policy, One Gustave L Levy Place, Box 1077, New York, NY 10029, USA
| | - Jan Sundquist
- Lund University, Centre for Primary Health Care Research, Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
| | - Marilyn A Winkleby
- Stanford University, Stanford Prevention Research Centre, Stanford, CA, USA
| | - Kristina Sundquist
- Lund University, Centre for Primary Health Care Research, Clinical Research Centre, Skåne University Hospital, Malmö, Sweden
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89
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Ren Y, Fei H, Liang X, Ji D, Cheng M. A hybrid neural network model for predicting kidney disease in hypertension patients based on electronic health records. BMC Med Inform Decis Mak 2019; 19:51. [PMID: 30961614 PMCID: PMC6454594 DOI: 10.1186/s12911-019-0765-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Disease prediction based on Electronic Health Records (EHR) has become one hot research topic in biomedical community. Existing work mainly focuses on the prediction of one target disease, and little work is proposed for multiple associated diseases prediction. Meanwhile, a piece of EHR usually contains two main information: the textual description and physical indicators. However, existing work largely adopts statistical models with discrete features from numerical physical indicators in EHR, and fails to make full use of textual description information. Methods In this paper, we study the problem of kidney disease prediction in hypertension patients by using neural network model. Specifically, we first model the prediction problem as a binary classification task. Then we propose a hybrid neural network which incorporates Bidirectional Long Short-Term Memory (BiLSTM) and Autoencoder networks to fully capture the information in EHR. Results We construct a dataset based on a large number of raw EHR data. The dataset consists of totally 35,332 records from hypertension patients. Experimental results show that the proposed neural model achieves 89.7% accuracy for the task. Conclusions A hybrid neural network model was presented. Based on the constructed dataset, the comparison results of different models demonstrated the effectiveness of the proposed neural model. The proposed model outperformed traditional statistical models with discrete features and neural baseline systems.
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Affiliation(s)
- Yafeng Ren
- Guangdong Collaborative Innovation Center for Language Research and Services, Guangdong University of Foreign Studies, Guangzhou, China
| | - Hao Fei
- School of Cyber Science and Engineering, Wuhan University, Wuhan, China
| | - Xiaohui Liang
- School of Health Sciences, Wuhan University, Wuhan, China.
| | - Donghong Ji
- Guangdong Collaborative Innovation Center for Language Research and Services, Guangdong University of Foreign Studies, Guangzhou, China
| | - Ming Cheng
- The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
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90
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Maternal Venous Hemodynamic Dysfunction in Proteinuric Gestational Hypertension: Evidence and Implications. J Clin Med 2019; 8:jcm8030335. [PMID: 30862007 PMCID: PMC6462953 DOI: 10.3390/jcm8030335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/26/2019] [Accepted: 03/05/2019] [Indexed: 01/21/2023] Open
Abstract
This review summarizes current knowledge from experimental and clinical studies on renal function and venous hemodynamics in normal pregnancy, in gestational hypertension (GH) and in two types of preeclampsia: placental or early-onset preeclampsia (EPE) and maternal or late-onset (LPE) preeclampsia, presenting at <34 weeks and ≥34 weeks respectively. In addition, data from maternal venous Doppler studies are summarized, showing evidence for (1) the maternal circulation functioning closer to the upper limits of capacitance than in non-pregnant conditions, with intrinsic risks for volume overload, (2) abnormal venous Doppler measurements obtainable in preeclampsia, more pronounced in EPE than LPE, however not observed in GH, and (3) abnormal venous hemodynamic function installing gradually from first to third trimester within unique pathways of general circulatory deterioration in GH, EPE and LPE. These associations have important clinical implications in terms of screening, diagnosis, prevention and management of gestational hypertensive diseases. They invite for further hypothesis-driven research on the role of retrograde venous congestion in the etiology of preeclampsia-related organ dysfunctions and their absence in GH, and also challenge the generally accepted view of abnormal placentation as the primary cause of preeclampsia. The striking similarity between abnormal maternal venous Doppler flow patterns and those observed at the ductus venosus and other abdominal veins of the intra-uterine growth restricted fetus, also invites to explore the role of venous congestion in the intra-uterine programming of some adult diseases.
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91
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Holzer S, Schoeps DDO, Suano-Souza FI, Gessulo ADV, Hix S, Fonseca FLA, Sarni ROS. Renal function in prepubertal children born with very low birthweight. Nutrition 2019; 62:20-24. [PMID: 30826595 DOI: 10.1016/j.nut.2018.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/03/2018] [Accepted: 11/21/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate estimated glomerular filtration rates (eGFR) and markers of renal function in very low birthweight (VLBW) children and to relate these parameters to current nutritional status. METHODS A cross-sectional and controlled study was performed with prepubertal children between ages 5 and 10, including 44 VLBW participants and 30 healthy participants born at full term with an adequate birthweight (control group). The following data were collected: perinatal history; current weight, height and waist circumference; blood pressure (three measures); blood creatinine, urea, uric acid, cystatin-C, and neutrophil gelatinase-associated lipocalin levels; and urine albumin, creatinine, and calcium levels. RESULTS Blood pressure, eGFR, albuminuria, concentrations of cystatin-C, neutrophil gelatinase-associated lipocalin, uric acid, urea, creatinine, and fractional calcium excretion did not differ between VLBW and control groups. Regarding the VLBW group, there was no difference in eGFR, albuminuria, and other markers of renal injury in overweight or obese children compared with children with a normal body mass index. CONCLUSIONS Prepubertal children born with VLBW did not have altered renal function, regardless of their current nutritional status.
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Affiliation(s)
- Simone Holzer
- Department of Pediatrics, Faculdade de Medicina do ABC, Santo Andre, Brazil
| | | | - Fabiola Isabel Suano-Souza
- Department of Pediatrics, Faculdade de Medicina do ABC, Santo Andre, Brazil; Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina, São Paulo, Brazil.
| | - Anelise Del Vecchio Gessulo
- Department of Pediatrics, Faculdade de Medicina do ABC, Santo Andre, Brazil; Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
| | - Sonia Hix
- Department of Biochemistry and Clinical Biochemistry, Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Fernando Luiz Affonso Fonseca
- Laboratory of Clinical Analysis, Pharmaceutical Sciences and Management in Environmental Health, Faculdade de Medicina do ABC, Santo Andre, Brazil
| | - Roseli Oselka Saccardo Sarni
- Department of Pediatrics, Faculdade de Medicina do ABC, Santo Andre, Brazil; Department of Pediatrics, Federal University of São Paulo-Escola Paulista de Medicina, São Paulo, Brazil
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92
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Parisi F, di Bartolo I, Savasi VM, Cetin I. Micronutrient supplementation in pregnancy: Who, what and how much? Obstet Med 2019; 12:5-13. [PMID: 30891086 PMCID: PMC6416688 DOI: 10.1177/1753495x18769213] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 03/05/2018] [Indexed: 12/22/2022] Open
Abstract
Pregnancy represents a period of major physiological and metabolic change, aiming to ensure proper fetal growth and development, as well as maternal preservation. This review focuses on maternal nutrition, and particularly on micronutrient deficiencies and supplementation during pregnancy. Nutrient deficiencies and consequences in pregnant women are presented, with an overview of current recommendations for dietary supplementation in pregnancy, even considering the risk of micronutrient overload. Appropriate universal supplementation and prophylaxis/treatment of nutritional needs currently appear to be the most cost-effective goal in low-income countries, thus ensuring adequate intake of key elements including folate, iron, calcium, vitamin D and A. In high-income countries, a proper nutritional assessment and counselling should be mandatory in obstetric care in order to normalize pregestational body mass index, choose a healthy dietary pattern and evaluate the risk of deficiencies.
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Affiliation(s)
- F Parisi
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - I di Bartolo
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - VM Savasi
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
| | - I Cetin
- Center for Fetal Research Giorgio Pardi, Department
of Biomedical and Clinical Sciences, Università degli Studi di Milano, Hospital
Luigi Sacco, Unit of Obstetrics and Gynecology, Milan, Italy
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93
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Upadhyay RP, Naik G, Choudhary TS, Chowdhury R, Taneja S, Bhandari N, Martines JC, Bahl R, Bhan MK. Cognitive and motor outcomes in children born low birth weight: a systematic review and meta-analysis of studies from South Asia. BMC Pediatr 2019; 19:35. [PMID: 30696415 PMCID: PMC6350290 DOI: 10.1186/s12887-019-1408-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/17/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND South Asia contributes substantially to global low birth weight population (i.e. those with birth weight < 2500 g). Synthesized evidence is lacking on magnitude of cognitive and motor deficits in low birth weight (LBW) children compared to those with normal birth weight (NBW) (i.e. birth weight ≥ 2500 g). The meta-analysis aimed to generate this essential evidence. METHODS Literature search was performed using PubMed and Google Scholar. Original research articles from south Asia that compared cognitive and/or motor scores among LBW and NBW individuals were included. Weighted mean differences (WMD) and pooled relative risks (RR) were calculated. All analyses were done using STATA 14 software. RESULTS Nineteen articles (n = 5999) were included in the analysis. Children < 10 years of age born LBW had lower cognitive (WMD -4.56; 95% CI: -6.38, - 2.74) and motor scores (WMD -4.16; 95% CI: -5.42, - 2.89) compared to children with NBW. Within LBW children, those with birth weight < 2000 g had much lower cognitive (WMD -7.23, 95% CI; - 9.20, - 5.26) and motor scores (WMD -6.45, 95% CI; - 9.64, - 3.27). CONCLUSIONS In south Asia, children born LBW, especially with < 2000 g birth weight, have substantial cognitive and motor impairment compared to children with NBW. Early child development interventions should lay emphasis to children born LBW.
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Affiliation(s)
- Ravi Prakash Upadhyay
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
| | - Gitismita Naik
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Nita Bhandari
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Jose Carlos Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Maharaj Kishan Bhan
- Indian Institute of Technology (IIT), New Delhi, India.,Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), New Delhi, India
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94
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The relationship between maternal obesity and diabetes during pregnancy on offspring kidney structure and function in humans: a systematic review. J Dev Orig Health Dis 2018; 10:406-419. [PMID: 30411699 DOI: 10.1017/s2040174418000867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Evidence from animal models indicates that exposure to an obesogenic or hyperglycemic intrauterine environment adversely impacts offspring kidney development and renal function. However, evidence from human studies has not been evaluated systematically. Therefore, the aim of this systematic review was to synthesize current research in humans that has examined the relationship between gestational obesity and/or diabetes and offspring kidney structure and function. Systematic electronic database searches were conducted of five relevant databases (CINAHL, Cochrane, EMBASE, MEDLINE and Scopus). Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed, and articles screened by two independent reviewers generated nine eligible papers for inclusion. Six studies were assessed as being of 'neutral' quality, two of 'negative' and one 'positive' quality. Observational studies suggest that offspring exposed to a hyperglycemic intrauterine environment are more likely to display markers of renal dysfunction and are at higher risk of end-stage renal disease. There was limited and inconsistent evidence for a link between exposure to an obesogenic intrauterine environment and offspring renal outcomes. Offspring renal outcome measures across studies were diverse, with a large variation in offspring age at follow-up, limiting comparability across studies. The collective current body of evidence suggests that intrauterine exposure to maternal obesity and/or diabetes adversely impacts renal programming in offspring, with an increased risk of kidney disease in adulthood. Further high-quality, longitudinal, prospective cohort studies that measure indicators of offspring renal development and function, including fetal kidney volume and albuminuria, at standardized follow-up time points, are warranted.
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95
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Sanders AP, Svensson K, Gennings C, Burris HH, Oken E, Amarasiriwardena C, Basnet P, Pizano-Zarate ML, Schnaas L, Tamayo-Ortiz M, Baccarelli AA, Satlin LM, Wright RO, Tellez-Rojo MM. Prenatal lead exposure modifies the effect of shorter gestation on increased blood pressure in children. ENVIRONMENT INTERNATIONAL 2018; 120:464-471. [PMID: 30145310 PMCID: PMC6354251 DOI: 10.1016/j.envint.2018.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 05/18/2023]
Abstract
BACKGROUND High blood pressure (BP) in childhood is frequently renal in origin and a risk factor for adult hypertension and cardiovascular disease. Shorter gestations are a known risk factor for increased BP in adults and children, due in part to a nephron deficit in children born preterm. As nephrogenesis is incomplete until 36 weeks gestation, prenatal lead exposure occurring during a susceptible period of renal development may contribute to programming for later life renal disease. The relationship between shorter gestation and children's BP has not yet been explored to identify i) critical windows using nonlinear piecewise models or ii) combined with other early life risk factors such as prenatal lead exposure. OBJECTIVES (1) To evaluate the nonlinear relationship between lower gestational age and childhood BP measured at 4-6 years of age, and (2) to investigate modification by prenatal lead exposure. METHODS In a prospective longitudinal birth cohort, we assessed 565 children between 4 and 6 years of age (mean: 4.8 years) in the PROGRESS cohort in Mexico City, Mexico. Gestational age at delivery was calculated using maternal report of last menstrual period (LMP) and confirmed with Capurro physical examination at birth. We measured pregnant women's blood lead levels (BLLs) in the second trimester via inductively coupled plasma-mass spectrometry and children's BP using an automated device. We performed both linear and nonlinear piecewise regression analyses to examine associations of gestational age with children's BP adjusting for children's age, sex, height, prenatal exposure to smoke, and maternal socioeconomic status. We stratified to assess modification by prenatal lead exposure, and used a data-adaptive approach to identify a lead cutpoint. RESULTS Maternal second trimester BLLs ranged from 0.7 to 17.8 μg/dL with 112 (20%) women above the CDC guideline level of 5 μg/dL. In adjusted linear regression models, a one week reduction in gestational age was associated with a 0.5 mm Hg (95%CI: 0.2, 0.8) increase in SBP and a 0.4 mm Hg (95%CI 0.1, 0.6) increase in DBP. Our nonlinear models suggested evidence for different magnitude estimates on either side of an estimated join-point at 35.9 weeks' gestation, but did not reach statistical significance. However, when stratified by prenatal lead exposure, we identified a cutpoint lead level of concern of 2.5 μg/dL that suggested an interaction between gestational age and blood lead. Specifically, for BLLs ≥ 2.5 μg/dL, SBP was 1.6 (95%CI: 0.3, 2.9) mm Hg higher per each week reduction in gestational age among children born before 37.0 weeks; and among children born after 37.0 weeks, this relationship was attenuated yet remained significant [β: 0.9, 95%CI (0.2, 1.6)]. At BLLs below 2.5 μg/dL, there was no appreciable association between lower gestational age and SBP. CONCLUSIONS Our findings suggest that shorter gestation combined with higher prenatal lead exposure contributes to a higher risk of increased SBP at 4-6 years of age, particularly among infants born <37 weeks gestation. Our results underscore the importance of preventing prenatal lead exposure - even levels as low as 2.5 μg/dL - especially among pregnant women at risk for preterm birth. Given that high BP in childhood is a risk factor for adult hypertension and cardiovascular disease later in life, these results may have implications that extend across the life span.
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Affiliation(s)
- Alison P Sanders
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Lautenberg Environmental Health Sciences Laboratory, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Katherine Svensson
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Heather H Burris
- Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Chitra Amarasiriwardena
- Lautenberg Environmental Health Sciences Laboratory, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priyanka Basnet
- Lautenberg Environmental Health Sciences Laboratory, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - María Luisa Pizano-Zarate
- Division of Community Interventions Research, National Institute of Perinatology, Mexico City, Mexico
| | - Lourdes Schnaas
- Division of Community Interventions Research, National Institute of Perinatology, Mexico City, Mexico
| | - Marcela Tamayo-Ortiz
- National Council of Science and Technology (CONACYT), Mexico City, Mexico; Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Lisa M Satlin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Lautenberg Environmental Health Sciences Laboratory, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martha M Tellez-Rojo
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
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96
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Ojeda NB, Alexander BT. Ex Utero Renal Maturation and Reduced Kidney Volume a Predictor of Increased Cardiorenal Risk. Hypertension 2018; 72:832-833. [PMID: 30354727 DOI: 10.1161/hypertensionaha.118.11678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Norma B Ojeda
- From the Departments of Pediatrics (N.B.O.), University of Mississippi-Medical Center, Jackson, MS
| | - Barbara T Alexander
- Physiology and Biophysics (B.T.A.), University of Mississippi-Medical Center, Jackson, MS
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97
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Ruggajo P, Leh S, Svarstad E, Marti HP, Vikse BE. Low birth weight associates with glomerular area in young male IgA nephropathy patients. BMC Nephrol 2018; 19:287. [PMID: 30348100 PMCID: PMC6198493 DOI: 10.1186/s12882-018-1070-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 10/05/2018] [Indexed: 03/19/2023] Open
Abstract
Background In a recent study we demonstrated that low birth weight (LBW) was associated with increased risk of progressive IgA nephropathy (IgAN). In the present study we investigate whether this could be explained by differences in glomerular morphological parameters. Methods The Medical Birth Registry of Norway has registered all births since 1967 and the Norwegian Kidney Biopsy Registry has registered all kidney biopsies since 1988. Patients diagnosed with IgAN, registered birth weight and estimated glomerular filtration rate above 60 ml/min/1.73m2 at time of diagnosis were eligible for inclusion. Patients were included in a case-control manner based on whether or not they had LBW or were small for gestational age (SGA). Glomerular area, volume and density were measured using high resolution digital images and differences were compared between groups. Results We included 51 IgAN patients with a mean age of 23.6 years, 47.1% male. Compared to IgAN patients without LBW or SGA, IgAN patients with LBW and/or SGA had larger glomerular area (16,235 ± 3744 vs 14,036 ± 3502 μm2, p-value 0.04). This was significant for total cohort and male but not female. On separate analysis by gender, glomerular area was significantly larger only in males (17,636 ± 3285 vs 13,346 ± 2835 μm2, p-value 0.004). Glomerular density was not different between groups. In adjusted linear regression analysis, glomerular area was negatively associated with birth weight. Conclusion Among young adult IgAN patients, low birth weight is associated with having larger glomerular area, especially in males. Larger glomeruli may be a sign of congenital nephron deficit that may explain the increased risk of progressive IgAN. Electronic supplementary material The online version of this article (10.1186/s12882-018-1070-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paschal Ruggajo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), P.O.Box 65001, Dar es Salaam, Tanzania. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Sabine Leh
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Einar Svarstad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Egil Vikse
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Medicine, Haugesund Hospital, Haugesund, Norway
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98
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Shalaby MA, Sawan ZA, Nawawi E, Alsaedi S, Al-Wassia H, Kari JA. Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study. Pediatr Nephrol 2018; 33:1617-1624. [PMID: 29869723 DOI: 10.1007/s00467-018-3966-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in neonates admitted to the neonatal intensive care unit (NICU). AKI is associated with increased morbidity and mortality and a greater long-term risk of chronic kidney disease. OBJECTIVES To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU. METHODS This single-center prospective cohort study included all infants who received level II or III NICU care during 2015 (January to December). We excluded infants who survived less than 48 h after admission, had evidence of congenital renal anomalies, or had insufficient data. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Both AKI and non-AKI neonates were prospectively followed up until NICU discharge. Outcomes studied included mortality and length of NICU stay. The results of adjusted risk analyses were expressed as relative risk (RR) with 95% confidence interval (95% CI). RESULTS The incidence of AKI (modified neonatal KDIGO stages) was 56% (120/214 patients). Compared with neonates without AKI, those with AKI had a lower birth weight (2202 ± 816 vs. 1570 ± 776 g; p < 0.001) and a lower gestational age (35 ± 3 vs. 32 ± 4 weeks; p < 0.001). After adjustment for potential confounders, only gestational age (RR, 4.8; 95% CI, 3-9) and perinatal depression (RR, 10; 95% CI, 2-46) were significantly associated with an increased risk of AKI. For infants with gestational age < 32 weeks, only the Clinical Risk Index for Babies (CRIB II) score was associated with an increased risk of AKI (RR, 1.9; 95% CI, 1-3). After adjustment for gestational age, AKI was significantly associated with mortality (RR, 5.4; 95% CI, 2-14), but not with the length of hospital stay (LOS) (p = 0.133). However, the AKI group had a significantly longer LOS (mean difference: 14 days; 95% CI, 5.5-23 days), and 33 patients (27.5%) with AKI were discharged with abnormally high serum creatinine levels (> 65 μmol/L). CONCLUSION AKI occurred in more than half of all NICU admissions, was associated with an increased risk of mortality, and had a higher incidence among smaller and sicker infants. Therefore, close monitoring of renal function during hospitalization and after discharge is warranted in such infants.
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Affiliation(s)
- Mohamed A Shalaby
- Pediatric Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Zinab A Sawan
- Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia.
| | - Esraa Nawawi
- Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia
| | - Saad Alsaedi
- Neonatal Intensive Care Unit, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Heidi Al-Wassia
- Neonatal Intensive Care Unit, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Jameela A Kari
- Pediatric Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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99
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Effect of early postnatal nutrition on chronic kidney disease and arterial hypertension in adulthood: a narrative review. J Dev Orig Health Dis 2018; 9:598-614. [PMID: 30078383 DOI: 10.1017/s2040174418000454] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Intrauterine growth restriction (IUGR) has been identified as a risk factor for adult chronic kidney disease (CKD), including hypertension (HTN). Accelerated postnatal catch-up growth superimposed to IUGR has been shown to further increase the risk of CKD and HTN. Although the impact of excessive postnatal growth without previous IUGR is less clear, excessive postnatal overfeeding in experimental animals shows a strong impact on the risk of CKD and HTN in adulthood. On the other hand, food restriction in the postnatal period seems to have a protective effect on CKD programming. All these effects are mediated at least partially by the activation of the renin-angiotensin system, leptin and neuropeptide Y (NPY) signaling and profibrotic pathways. Early nutrition, especially in the postnatal period has a significant impact on the risk of CKD and HTN at adulthood and should receive specific attention in the prevention of CKD and HTN.
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100
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Benedetti V, Brizi V, Guida P, Tomasoni S, Ciampi O, Angeli E, Valbusa U, Benigni A, Remuzzi G, Xinaris C. Engineered Kidney Tubules for Modeling Patient-Specific Diseases and Drug Discovery. EBioMedicine 2018; 33:253-268. [PMID: 30049385 PMCID: PMC6085557 DOI: 10.1016/j.ebiom.2018.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/25/2018] [Accepted: 06/06/2018] [Indexed: 12/18/2022] Open
Abstract
The lack of engineering systems able to faithfully reproduce complex kidney structures in vitro has made it difficult to efficiently model kidney diseases and development. Using polydimethylsiloxane (PDMS) scaffolds and a kidney-derived cell line we developed a system to rapidly engineer custom-made 3D tubules with typical renal epithelial properties. This system was successfully employed to engineer patient-specific tubules, to model polycystic kidney disease (PKD) and test drug efficacy, and to identify a potential new pharmacological treatment. By optimizing our system we constructed functional ureteric bud (UB)-like tubules from human induced pluripotent stem cells (iPSCs), and identified a combination of growth factors that induces budding morphogenesis like embryonic kidneys do. Finally, we applied this assay to investigate budding defects in UB-like tubules derived from a patient with a PAX2 mutation. Our system enables the modeling of human kidney disease and development, drug testing and discovery, and lays the groundwork for engineering anatomically correct kidney tissues in vitro and developing personalized medicine applications.
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Affiliation(s)
- Valentina Benedetti
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, 24126 Bergamo, Italy
| | - Valerio Brizi
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, 24126 Bergamo, Italy
| | - Patrizia Guida
- Nanomed Laboratories, Dipartimento di Fisica, Università di Genova, 16146 Genova, Italy
| | - Susanna Tomasoni
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, 24126 Bergamo, Italy
| | - Osele Ciampi
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, 24126 Bergamo, Italy
| | - Elena Angeli
- Nanomed Laboratories, Dipartimento di Fisica, Università di Genova, 16146 Genova, Italy
| | - Ugo Valbusa
- Nanomed Laboratories, Dipartimento di Fisica, Università di Genova, 16146 Genova, Italy
| | - Ariela Benigni
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, 24126 Bergamo, Italy
| | - Giuseppe Remuzzi
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, 24126 Bergamo, Italy; 'L. Sacco' Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy; Unit of Nephrology and Dialysis, Azienda Socio-Sanitaria Territoriale (ASST) Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Christodoulos Xinaris
- IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri', Centro Anna Maria Astori, Science and Technology Park Kilometro Rosso, 24126 Bergamo, Italy.
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