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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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52
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Chatmethakul T, Roghair RD. Risk of hypertension following perinatal adversity: IUGR and prematurity. J Endocrinol 2019; 242:T21-T32. [PMID: 30657741 PMCID: PMC6594910 DOI: 10.1530/joe-18-0687] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/18/2019] [Indexed: 12/12/2022]
Abstract
Consistent with the paradigm shifting observations of David Barker and colleagues that revealed a powerful relationship between decreased weight through 2 years of age and adult disease, intrauterine growth restriction (IUGR) and preterm birth are independent risk factors for the development of subsequent hypertension. Animal models have been indispensable in defining the mechanisms responsible for these associations and the potential targets for therapeutic intervention. Among the modifiable risk factors, micronutrient deficiency, physical immobility, exaggerated stress hormone exposure and deficient trophic hormone production are leading candidates for targeted therapies. With the strong inverse relationship seen between gestational age at delivery and the risk of hypertension in adulthood trumping all other major cardiovascular risk factors, improvements in neonatal care are required. Unfortunately, therapeutic breakthroughs have not kept pace with rapidly improving perinatal survival, and groundbreaking bench-to-bedside studies are urgently needed to mitigate and ultimately prevent the tsunami of prematurity-related adult cardiovascular disease that may be on the horizon. This review highlights our current understanding of the developmental origins of hypertension and draws attention to the importance of increasing the availability of lactation consultants, nutritionists, pharmacists and physical therapists as critical allies in the battle that IUGR or premature infants are waging not just for survival but also for their future cardiometabolic health.
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Affiliation(s)
- Trassanee Chatmethakul
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Robert D Roghair
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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53
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Coats LE, Davis GK, Newsome AD, Ojeda NB, Alexander BT. Low Birth Weight, Blood Pressure and Renal Susceptibility. Curr Hypertens Rep 2019; 21:62. [PMID: 31228030 PMCID: PMC8109258 DOI: 10.1007/s11906-019-0969-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF THE REVIEW The purpose of this review is to highlight the clinical significance of increased renal risk that has its origins in fetal life. This review will also discuss the critical need to identify therapeutic interventions for use in a pregnancy complicated by placental dysfunction and intrauterine growth restriction that can mitigate the developmental origins of kidney disease without inflicting additional harm on the developing fetus. RECENT FINDINGS A reduction in nephron number is a contributory factor in the pathogenesis of hypertension and kidney disease in low birth weight individuals. Reduced nephron number may heighten susceptibility to a secondary renal insult, and recent studies suggest that perinatal history including birth weight should be considered in the assessment of renal risk in kidney donors. This review highlights current findings related to placental dysfunction, intrauterine growth restriction, increased risk for renal injury and disease, and potential therapeutic interventions.
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Affiliation(s)
- Laura E Coats
- Department of Physiology and Biophysics, Mississippi Center for Excellence in Perinatal Health, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Gwendolyn K Davis
- Department of Physiology and Biophysics, Mississippi Center for Excellence in Perinatal Health, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Ashley D Newsome
- Department of Physiology and Biophysics, Mississippi Center for Excellence in Perinatal Health, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Norma B Ojeda
- Department of Pediatrics, Mississippi Center for Excellence in Perinatal Health, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Barbara T Alexander
- Department of Physiology and Biophysics, Mississippi Center for Excellence in Perinatal Health, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
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54
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Fattah H, Layton A, Vallon V. How Do Kidneys Adapt to a Deficit or Loss in Nephron Number? Physiology (Bethesda) 2019; 34:189-197. [PMID: 30968755 DOI: 10.1152/physiol.00052.2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A deficit or loss in the number of nephrons, the functional unit of the kidney, can induce compensatory growth and hyperfunction of remaining nephrons. An increase in single nephron glomerular filtration rate (SNGFR) aims to compensate but may be deleterious in the long term. The increase in SNGFR is determined by the dynamics of nephron loss, total remaining GFR, the body's excretory demand, and the functional capacity to sustain single nephron hyperfunction.
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Affiliation(s)
- Hadi Fattah
- Departments of Medicine and Pharmacology, Division of Nephrology and Hypertension, University of California San Diego , San Diego, California.,Department of Veterans Affairs, San Diego Healthcare System, San Diego, California
| | - Anita Layton
- Department of Applied Mathematics and School of Pharmacy, University of Waterloo , Waterloo, Ontario , Canada.,Departments of Mathematics, Biomedical Engineering, and Medicine, Duke University , Durham, North Carolina
| | - Volker Vallon
- Departments of Medicine and Pharmacology, Division of Nephrology and Hypertension, University of California San Diego , San Diego, California.,Department of Veterans Affairs, San Diego Healthcare System, San Diego, California
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55
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Kawabe H, Azegami T, Takeda A, Kanda T, Saito I, Saruta T, Hirose H. Features of and preventive measures against hypertension in the young. Hypertens Res 2019; 42:935-948. [PMID: 30894695 PMCID: PMC8075862 DOI: 10.1038/s41440-019-0229-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 12/14/2022]
Abstract
The Japanese hypertension guidelines report that essential hypertension is detected in 1–3% of upper elementary and high school students during blood pressure (BP) screenings. Hypertension in these age groups is an emerging public health concern mainly attributed to the rising rate of pediatric obesity. Considering the existence of BP tracking phenomenon, early preventive education and instruction are necessary, especially for male students with moderately elevated BP showing a tendency toward obesity, despite the low prevalence of hypertension in high school students. Students with a positive family history of hypertension and those born with low birth weight need the same measures. Lifestyle habits, such as increased alcohol intake, dramatically change once students begin university; thus, early education and instruction regarding the factors influencing BP are necessary. In particular, for male students with higher BP during high school, caution regarding increased body weight is required irrespective of their level of obesity. Young adults aged <40 years should be educated about the association between body weight and hypertension. Particular caution surrounding lifestyle habits, including drinking and smoking, is warranted in male hypertensive subjects because hypertension at a young age is strongly associated with obesity. BP monitoring and the management of obesity should be considered efficient approaches to the detection and treatment of hypertension. For the lifetime prevention of hypertension, it is essential to be aware of one’s health status and learn about healthy lifestyles beginning in childhood. BP measurement may be an appropriate means to achieve this goal.
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Affiliation(s)
- Hiroshi Kawabe
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Tatsuhiko Azegami
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Health Center, Keio University, Kanagawa, Japan
| | - Ayano Takeda
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Health Center, Keio University, Kanagawa, Japan
| | - Takeshi Kanda
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ikuo Saito
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takao Saruta
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Hirose
- Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Health Center, Keio University, Kanagawa, Japan
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56
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Kshatriya GK, Acharya SK. Prevalence and risks of hypertension among Indian tribes and its status among the lean and underweight individuals. Diabetes Metab Syndr 2019; 13:1105-1115. [PMID: 31336452 DOI: 10.1016/j.dsx.2019.01.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/21/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With the increased worldwide prevalence of hypertension among the underprivileged populations, fewerstudies have reported such risks among Indian tribes. In the context of high prevalence of undernutrition, no such study has examined hypertension among lean and underweight Indian tribal individuals separately. METHODS We selected total samples of 1066 adult males and 1090 adult females in 20-60 years age-group cross-sectionally to examine the status of hypertension and its risks among nine major tribes in three Indian states; separate analyses for lean and underweight tribal individuals were done. RESULTS Increased prevalence of hypertension (females, 14.2%; males, 9.3%) was observed among the tribes with the overall percentage of individuals at adversity (hypertensive + isolated hypertensive) at more than 20% (males 20.1%; females 26.5%). Age-group-wise prevalence showed a sharp rise in the prevalence of hypertension in the 40 + year individuals; additionally, this rise was alarming among females. Undernutrition was observed to be a potential risk factor as a remarkable prevalence of hypertension was observed among the undernourished (approximately 9%) and lean tribal participants (12%). Underweight females were observed to be at higher risk. Tribal statuses were observed to be alarming than the national trends due to their very low average BMI along with high average SBP. A curvilinear prevalence of hypertension was observed while comparing through both the nutritional extremes. CONCLUSION The increased prevalence and risks of hypertension in the background of lean and underweight status of Indian tribes indicates their epidemiological transition burdened with alarming cardio-metabolic health risks that warrant an early and consistent surveillance.
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Affiliation(s)
| | - Subhendu K Acharya
- National Institute of Epidemiology Social and Behavioural Sciences, Chennai, Tamilnadu, 600077, India.
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57
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Aydin M, Franke I, Kurylowicz L, Ganschow R, Lentze M, Born M, Hagemann R. The long-term outcome of childhood nephrotic syndrome in Germany: a cross-sectional study. Clin Exp Nephrol 2019; 23:676-688. [PMID: 30721392 DOI: 10.1007/s10157-019-01696-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/14/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Long-term outcomes of children with nephrotic syndrome have not been well described in the literature. METHODS Cross-sectional study data analysis of n = 43 patients with steroid-sensitive (SSNS) and n = 7 patients with steroid-resistant (SRNS) nephrotic syndrome were retrospectively collected; patients were clinically examined at a follow-up visit (FUV), on average 30 years after onset, there was the longest follow-up period to date. RESULTS The mean age at FUV was 33.6 years (14.4-50.8 years, n = 41). The mean age of patients with SSNS at onset was 4.7 years (median 3.8 years (1.2-14.5 years), the mean number of relapses was 5.8 (0 to 29 relapses). Seven patients (16.3%) had no relapses. Eleven patients were "frequent relapsers" (25.6%) and four patients still had relapses beyond the age of 18 years. Except of cataracts and arterial hypertension, there were no negative long-term outcomes and only one patient was using immunosuppressant therapy at FUV. 55% of patients suffered from allergies and 47.5% had hypercholesterolemia. Two patients suffered a heart attack in adulthood. A younger age at onset (< 4 years) was a risk factor for frequent relapses. An early relapse (within 6 months after onset) was a risk factor and a low birth weight was not a significant risk factor for a complicated NS course. The mean age of patients with SRNS at onset was 4.6 ± 4.4 years and 27.5 ± 9.9 years at FUV. Three patients received kidney transplantations. CONCLUSIONS The positive long-term prognosis of SSNS can reduce the concern of parents about the probability of the child developing a chronic renal disease during the clinical course after onset.
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Affiliation(s)
- Malik Aydin
- Department of General Pediatrics, University Children's Hospital Bonn, Bonn, Germany. .,HELIOS University Medical Center Wuppertal, Children's Hospital, Center for Clinical and Translational Research (CCTR), Center for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany.
| | - Ingo Franke
- Department of General Pediatrics, University Children's Hospital Bonn, Bonn, Germany
| | - Lisa Kurylowicz
- Department of General Pediatrics, University Children's Hospital Bonn, Bonn, Germany
| | - Rainer Ganschow
- Department of General Pediatrics, University Children's Hospital Bonn, Bonn, Germany
| | - Michael Lentze
- Department of General Pediatrics, University Children's Hospital Bonn, Bonn, Germany
| | - Mark Born
- Department of Radiology, Pediatric Radiology, University Hospital Bonn, Bonn, Germany
| | - Rebekka Hagemann
- Department of General Pediatrics, University Children's Hospital Bonn, Bonn, Germany
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58
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Kamianowska M, Szczepański M, Kulikowska EE, Bebko B, Wasilewska A. The Tubular Damage Markers: Neutrophil Gelatinase-Associated Lipocalin and Kidney Injury Molecule-1 in Newborns with Intrauterine Growth Restriction. Neonatology 2019; 115:169-174. [PMID: 30513528 DOI: 10.1159/000494102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is a poorly understood complication of pregnancy. It may be associated with various diseases in adulthood, such as hypertension, cardiovascular disease, insulin resistance, and end-stage renal disease. OBJECTIVES The aim of this study was to check whether IUGR affects the function of renal tubules, as assessed by the tubular damage markers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1). METHODS The study included 126 term neonates. Thirty-eight newborns were the result of pregnancies complicated by IUGR. Eighty-eight healthy newborns were the result of normal pregnancies with no prenatal or perinatal complications. The concentrations of urinary NGAL and KIM-1 were determined with a commercially available ELISA kit and were normalized for urinary creatinine (Cr) concentration. RESULTS We found a significantly higher urinary concentration of NGAL and NGAL/Cr ratio in newborns from pregnancies complicated by IUGR when compared to the reference group. We found that female gender was associated with a higher concentration of urinary NGAL and also urinary NGAL/Cr. CONCLUSIONS This is the first work that demonstrates that urinary NGAL concentration and urinary NGAL/Cr are significantly higher in infants that are small for gestational age than in appropriate-for-gestational-age infants. This might indicate subclinical kidney damage in newborns with IUGR.
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Affiliation(s)
- Monika Kamianowska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Białystok, Białystok, Poland,
| | - Marek Szczepański
- Department of Neonatology and Neonatal Intensive Care, Medical University of Białystok, Białystok, Poland
| | - Elżbieta Ewa Kulikowska
- Department of Neonatology and Neonatal Intensive Care, Medical University of Białystok, Białystok, Poland
| | - Barbara Bebko
- Department of Neonatology and Neonatal Intensive Care, Medical University of Białystok, Białystok, Poland
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Białystok, Białystok, Poland
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59
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Kidney volume, kidney function, and ambulatory blood pressure in children born extremely preterm with and without nephrocalcinosis. Pediatr Nephrol 2019; 34:1765-1776. [PMID: 31338588 PMCID: PMC6775032 DOI: 10.1007/s00467-019-04293-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reduced kidney volume (KV) following prematurity is a proxy for reduced nephron number and is associated with the development of hypertension and end-stage renal disease in adults. We investigated whether extreme prematurity affects KV, function, and blood pressure in school-aged children and if nephrocalcinosis (NC) developed during the neonatal period had additional effects. METHODS We investigated 60 children at a mean age of 7.7 years: 20 born extremely preterm (EPT < 28 weeks gestational age with NC (NC+)), 20 born EPT without NC (NC-), and 19 born as full-term infants (control). We measured KV by ultrasound, collected blood and urine samples to evaluate renal function, and measured office and 24-h ambulatory blood pressure (ABPM). RESULTS Children born EPT had significantly smaller kidneys (EPT (NC+ NC-) vs control (estimated difference, 11.8 (CI - 21.51 to - 2.09 ml), p = 0.018) and lower but normal cystatin C-based glomerular filtration rate compared with control (estimated difference, - 10.11 (CI - 0.69 to - 19.5), p = 0.035). KV and function were not different between NC+ and NC- groups. Change in KV in relation to BSA (KV/BSA) from the neonatal period to school age showed significantly more EPT children with neonatal NC having a negative evolution of KV (p = 0.01). Blood pressure was normal and not different between the 3 groups. Fifty percent of EPT had a less than 10% day-to-night decline in ABPM. CONCLUSIONS Kidney growth and volume is affected by EPT birth with NC being a potential aggravating factor. Circadian blood pressure regulation seems abnormal in EPT-born children.
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60
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Sidiropoulou EJ, Paltoglou G, Valsamakis G, Margeli A, Mantzou A, Papassotiriou I, Hassiakos D, Iacovidou N, Mastorakos G. Biochemistry, hormones and adipocytokines in prepubertal children born with IUGR evoke metabolic, hepatic and renal derangements. Sci Rep 2018; 8:15691. [PMID: 30356143 PMCID: PMC6200759 DOI: 10.1038/s41598-018-34075-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/08/2018] [Indexed: 12/15/2022] Open
Abstract
Children born with IUGR develop features of the metabolic syndrome and exhibit deranged markers of hepatorenal physiology. Metabolic and hepatorenal biochemistry and the rs9939609 FTO polymorphism were investigated in prepubertal children born with IUGR. Ninety-eight prepubertal children (46 IUGR and 52 AGA), subdivided in <5 years and >5 years old groups were included. Anthropometry; creatinine, eGFR, urea, AST, ALT, triglycerides, uric acid, total cholesterol, HDL-c, LDL-c, glucose, C-peptide, insulin and glucagon z-scores; HOMA-IR; leptin and adiponectin concentrations; rs9939609 FTO polymorphism frequency were measured. In males, weight and ALT were higher and adiponectin was lower, in IUGR < 5 years; C-peptide, insulin and leptin were higher in IUGR > 5 years; C-peptide was higher in all IUGR, than the respective AGA. In females, creatinine and triglycerides were higher in IUGR < 5 years old; creatinine was higher and eGFR was lower in all IUGR, than the respective AGA. In males and females, creatinine was higher in all IUGR, than the respective AGA; C-peptide, insulin and HOMA-IR were lower, and AST was higher in IUGR < 5 than in IUGR > 5 years old. FTO rs9939609 frequency did not differ between IUGR and AGA. In conclusion prepubertal males born with IUGR increased weight, insulin and leptin and decreased adiponectin, as compared to males born AGA, emerge as early metabolic syndrome characteristics. The concentrations of these hormones do not differ between prepubertal males and females born with IUGR. Weight control, healthy nutrition and physical exercise should be recommended to these children. The deranged renal (particularly evident in females below the age of 5) and liver biochemistry in prepubertal children born with IUGR suggests that hepatorenal derangements might commence in utero. Regular checkup of biochemical and lipid profile is recommended for all children born with IUGR.
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Affiliation(s)
- Elpida J Sidiropoulou
- Endocrine Unit, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - George Paltoglou
- Endocrine Unit, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - George Valsamakis
- Endocrine Unit, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Alexandra Margeli
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Aimilia Mantzou
- First Department of Pediatrics, "Aghia Sophia" Children's Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Dimitrios Hassiakos
- Second Department of Obstetrics and Gynecology, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - Nicoletta Iacovidou
- Neonatal Department, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece
| | - George Mastorakos
- Endocrine Unit, "Aretaieion" Hospital, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece.
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61
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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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62
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Senra JC, Carvalho MA, Rodrigues AS, Krebs VLJ, Gibelli MABC, Francisco RPV, Bernardes LS. An unfavorable intrauterine environment may determine renal functional capacity in adulthood: a meta-analysis. Clinics (Sao Paulo) 2018; 73:e401. [PMID: 30365822 PMCID: PMC6172979 DOI: 10.6061/clinics/2018/e401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/02/2018] [Indexed: 11/18/2022] Open
Abstract
Since studies show that an unfavorable environment during intrauterine development predisposes individuals to several diseases in adulthood, our objective is to assess the relation between fetal growth restriction and chronic renal disease in adults. We searched four different electronic databases through November 2017: CENTRAL, EMBASE, LILACS and MEDLINE. We selected studies with longitudinal or transversal designs associating kidney function in adulthood with low birth weight. Two reviewers evaluated the inclusion criteria and the risk of bias and extracted data from the included papers. Thirteen studies were selected for the systematic review and meta-analysis. We observed increased risks of presenting end-stage renal disease (risk ratio 1.31, 95% confidence interval: 1.17, 1.47), a lower glomerular filtration rate (ml/min) (mean difference 7.14; 95% confidence interval: -12.12, -2.16), microalbuminuria (risk ratio 1.40; 95% confidence interval: 1.28, 1.52) and a small increase in the albumin/creatinine ratio (mean difference 0.46; 95% confidence interval: 0.03, 0.90) in the low birth weight patients, compared with control group. These findings suggest that low birth weight is associated with renal dysfunction in adults.
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Affiliation(s)
- Janaína Campos Senra
- Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Mariana Azevedo Carvalho
- Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Agatha Sacramento Rodrigues
- Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Vera Lúcia Jornada Krebs
- Unidade Neonatal, Departamento de Pediatria Faculdade de Medicina FMUSP, Universidade de Sao Paulo Sao Paulo, SP, BR
| | | | | | - Lisandra Stein Bernardes
- Departamento de Obstetricia e Ginecologia, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Vollsæter M, Halvorsen T, Markestad T, Øymar K, Ueland PM, Meyer K, Midttun Ø, Bjørke-Monsen AL. Renal function and blood pressure in 11 year old children born extremely preterm or small for gestational age. PLoS One 2018; 13:e0205558. [PMID: 30312323 PMCID: PMC6185834 DOI: 10.1371/journal.pone.0205558] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 09/27/2018] [Indexed: 12/31/2022] Open
Abstract
Background Preterm birth and low birth weight are associated with reduced nephron numbers and increased risk of hypertension and kidney disease in later life. Aims We tested the hypothesis that extremely preterm birth and intrauterine growth restriction is associated with decreased renal function in mid childhood. Methods At 11 years of age the following measures were obtained in a regional cohort of children born extremely premature (EP, i.e. < 28 weeks gestational age—GA) or with extremely low birth weight (ELBW, i.e. BW < 1000 grams) and in matched controls born at term with appropriate BW (AGA): Height, weight, abdominal circumference, triceps and subscapular skin fold thicknesses, blood pressure, plasma levels of creatinine, cystatin C and symmetric dimethyl arginine (SDMA). Small for gestational age (SGA) was defined as a BW < 10th percentile for GA. Glomerular filtration rate (GFR) was estimated according to the equations by Schwartz, Zappitelli and Gao. Results Fifty-seven of 61 eligible EP/ELBW children, 20 (35%) born SGA, and 54 controls, were assessed. Estimated GFR decreased while plasma SDMA increased from the children born AGA at term through those born preterm AGA to preterm SGA. Systolic BP was correlated to fat mass indices (p<0.03), but not to renal function (p>0.2) and did not differ between the groups. Conclusions Children born EP/ELBW, particularly those born SGA, had impaired renal function at age 11 years as judged from estimated GFRs and plasma levels of SDMA. Since reduced renal function is associated with an increased risk of later disease, these children should be followed in order to minimize additional risk factors.
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Affiliation(s)
- Maria Vollsæter
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- * E-mail: ,
| | - Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Trond Markestad
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Knut Øymar
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Stavanger University Hospital, Stavanger, Norway
| | - Per Magne Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Klaus Meyer
- Bevital A/S, Armauer Hansens Hus, Bergen, Norway
| | | | - Anne-Lise Bjørke-Monsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
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Urisarri A, Gil M, Mandiá N, Aldamiz-Echevarría L, Iria R, González-Lamuño D, Couce ML. Retrospective study to identify risk factors for chronic kidney disease in children with congenital solitary functioning kidney detected by neonatal renal ultrasound screening. Medicine (Baltimore) 2018; 97:e11819. [PMID: 30095653 PMCID: PMC6133615 DOI: 10.1097/md.0000000000011819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To evaluate the prognostic significance of factors frequently associated with a reduction in renal mass, such as prematurity, low birth weight, and congenital anomalies of kidney and urinary tract (CAKUT), in patients with solitary functioning kidney (SFK) and investigate signs of early renal injury due to glomerular hyperfiltration damage or dysplasia in the remaining kidney.Retrospective observational study of congenital SFK diagnosed and followed at a tertiary care hospital over a period of 10 years in which 32,900 newborns underwent routine neonatal abdominal ultrasound screening. We analyzed age at diagnosis, sex, gestational age, anthropometric measurements at birth and prenatal and neonatal ultrasound findings, in addition to follow-up data corresponding to imaging findings (ultrasound, micturating cystourethrography, dimercaptosuccinic acid renal, and scintigraphy), ipsilateral CAKUT, compensatory hypertrophy, and renal injury in the form of albuminuria, blood pressure, and estimated glomerular filtration rate (eGFR).In total, 128 congenital SFK cases were detected (1 per 257 live births). Of these, 117 (91.4%) were diagnosed by neonatal ultrasound screening and 44.5% of these had been previously identified by prenatal ultrasound. Neonatal ultrasound had a specificity of 100% and a sensitivity of 92.1%. Forty-five patients (35.2%) had ipsilateral CAKUT and the most common type was urinary collecting system anomalies (75.5%). Over a median follow-up of 6.3 years (1-10 years), compensatory renal hypertrophy was observed in 81 patients (63.7%), most of whom had ipsilateral CAKUT (76.1% vs 56.6% of patients without ipsilateral CAKUT). Albuminuria and hypertension were observed in 3.12% and 5% of patients, respectively, and both were associated with ipsilateral CAKUT (P < .05). In addition, 75% of albuminuria cases (P = .031), 83.3% of hypertension cases (P = .004), and 100% of decreased eGFRcases (P = .031) were significantly associated with CAKUT (renal parenchymal anomaly category), being the strongest predictor of GFR the presence or absence of CAKUT.Neonatal ultrasound screening is useful for the early diagnosis of SFK. The presence of ipsilateral CAKUT should be evaluated in all patients with SFK as congenital anomalies of the renal parenchyma are associated with a poorer prognosis. Because morbidity from CAKUTs may not develop until adulthood, patients should be closely followed throughout life.
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Affiliation(s)
- Adela Urisarri
- Neonatal Service. Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana
| | - Marta Gil
- Pediatric Nephrology Unit, Santiago de Compostela University Hospital, Santiago de Compostela
| | - Natalia Mandiá
- Neonatal Service. Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana
| | | | - Roca Iria
- Neonatal Service. Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana
| | - Domingo González-Lamuño
- Department of Pediatrics, University Hospital Marqués de Valdecilla-Universidad de Cantabria, Santander, Spain
| | - María-Luz Couce
- Neonatal Service. Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana
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Afolabi OA, Alagbonsi AI, Oyinloye RT, Salahdeen HM, Salman TM, Olatunji LA. High-fat diet reduces weight gain but increases other cardio-metabolic indices in offspring of normotensive and hypertensive rats. Arch Physiol Biochem 2018; 124:218-225. [PMID: 28952789 DOI: 10.1080/13813455.2017.1383441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study investigated the effect of post-natal consumption of high-fat diet (HFD) on cardio-metabolic indices in male offspring of hypertensive female rats. There were neither significant differences in body weight gain either in pups from normotensive or hypertensive dams that received normal diet during the post-weaning periods (except at 7th and 9th weeks), nor in both pup groups that received HFD. However, both pup groups that received HFD had reduced body weight gain when compared to their counterparts that received normal diet. Post-weaning administration of HFD to pups of hypertensive and normotensive dams significantly increased their blood glucose, pressure and lipid profiles when compared to those weaned to normal diet. It was concluded that male offspring consumption of HFD diet elicits cardio-metabolic disturbance that slightly depended of maternal cardiovascular status but majorly depended on post-weaning weight gain, while that elicited by maternal hypertension is not related to post-weaning weight gain.
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Affiliation(s)
- Oladele Ayobami Afolabi
- a Department of Physiology, College of Health Sciences , Ladoke Akintola University of Technology , Ogbosomo , Oyo , Nigeria
| | - Abdullateef Isiaka Alagbonsi
- b Department of Physiology, Faculty of Medicine and Health Sciences , University of Gitwe , Gitwe , Republic of Rwanda
| | - Roseline Toyosi Oyinloye
- a Department of Physiology, College of Health Sciences , Ladoke Akintola University of Technology , Ogbosomo , Oyo , Nigeria
| | | | - Toyin Mohammed Salman
- d Department of Physiology, College of Health Sciences , University of Ilorin , Ilorin , Kwara , Nigeria
| | - Lawrence Aderemi Olatunji
- d Department of Physiology, College of Health Sciences , University of Ilorin , Ilorin , Kwara , Nigeria
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Baum M. Role of renal sympathetic nerve activity in prenatal programming of hypertension. Pediatr Nephrol 2018; 33:409-419. [PMID: 27001053 DOI: 10.1007/s00467-016-3359-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/15/2016] [Accepted: 02/18/2016] [Indexed: 12/30/2022]
Abstract
Prenatal insults, such as maternal dietary protein deprivation and uteroplacental insufficiency, lead to small for gestational age (SGA) neonates. Epidemiological studies from many different parts of the world have shown that SGA neonates are at increased risk for hypertension and early death from cardiovascular disease as adults. Animal models, including prenatal administration of dexamethasone, uterine artery ligation and maternal dietary protein restriction, result in SGA neonates with fewer nephrons than controls. These models are discussed in this educational review, which provides evidence that prenatal insults lead to altered sodium transport in multiple nephron segments. The factors that could result in increased sodium transport are discussed, focusing on new information that there is increased renal sympathetic nerve activity that may be responsible for augmented renal tubular sodium transport. Renal denervation abrogates the hypertension in programmed rats but has no effect on control rats. Other potential factors that could cause hypertension in programmed rats, such as the renin-angiotensin system, are also discussed.
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Affiliation(s)
- Michel Baum
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Building, Dallas, TX, 75390-9063, USA. .,Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.
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Callaway DA, McGill-Vargas LL, Quinn A, Jordan JL, Winter LA, Anzueto D, Dick EJ, Blanco CL. Prematurity disrupts glomeruli development, whereas prematurity and hyperglycemia lead to altered nephron maturation and increased oxidative stress in newborn baboons. Pediatr Res 2018; 83:702-711. [PMID: 29166383 PMCID: PMC5902650 DOI: 10.1038/pr.2017.290] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 10/02/2017] [Indexed: 12/17/2022]
Abstract
BackgroundPremature birth occurs when nephrogenesis is incomplete and has been linked to increased renal pathologies in the adult. Metabolic factors complicating preterm birth may have additional consequences for kidney development. Here, we evaluated the effects of prematurity and hyperglycemia on nephrogenesis in premature baboons when compared with those in term animals.MethodsBaboons were delivered prematurely (67% gestation; n=9) or at term (n=7) and survived for 2-4 weeks. Preterm animals were classified by glucose control during the first 5 days of life: normoglycemic (PtN; serum glucose 50-100 mg/dl, n=6) and hyperglycemic (PtH; serum glucose 150-250 mg/dl, n=3). Kidneys were assessed histologically for glomeruli relative area, maturity, size, and overall morphology. Kidney lysates were evaluated for oxidative damage with 4-hydroxynonenal (4-HNE) antibody.ResultsHistological examination revealed decreased glomeruli relative area (P<0.05), fewer glomerular generations (P<0.01), and increased renal corpuscle area (P<0.001) in preterm compared with those in term animals. Numbers of apoptotic glomeruli were similar between groups. PtH kidneys exhibited reduced nephrogenic zone width (P<0.0001), increased numbers of mature glomeruli (P<0.05), and increased 4-HNE staining compared with those in PtN kidneys.ConclusionPrematurity interrupts normal kidney development, independent of glomerular cell apoptosis. When prematurity is complicated by hyperglycemia; kidney development shifts toward accelerated maturation and increased oxidative stress.
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Affiliation(s)
- Danielle A. Callaway
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900
| | - Lisa L. McGill-Vargas
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900,University Health System, Neonatology, San Antonio, Texas, 78229
| | - Amy Quinn
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900,University Health System, Neonatology, San Antonio, Texas, 78229
| | - Jasmine L. Jordan
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900
| | - Lauryn A. Winter
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900
| | - Diana Anzueto
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900
| | - Edward J. Dick
- Texas Biomedical Research Institute PO Box 760549 San Antonio, TX 78245-0549
| | - Cynthia L. Blanco
- Department of Pediatrics, Division of Neonatology, University of Texas Health Science Center, San Antonio, Texas 78229-3900,University Health System, Neonatology, San Antonio, Texas, 78229,Corresponding author: Cynthia L. Blanco, University of Texas Health Science Center San Antonio, Department of Pediatrics, Division of Neonatology, 7703 Floyd Curl Drive, MC-7812, San Antonio, TX, 78229, Phone: 210-567-5225, fax: 210-567-5169,
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Yamamura-Miyazaki N, Yamamoto K, Fujiwara K, Santo Y, Michigami T, Kitajima H, Satomura K. Risk factors associated with a decreased estimated glomerular filtration rate based on cystatin C levels in school-age children with extremely low birthweight. Nephrology (Carlton) 2018; 22:463-469. [PMID: 27126573 DOI: 10.1111/nep.12807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/15/2016] [Accepted: 04/24/2016] [Indexed: 11/27/2022]
Abstract
AIM A single centre retrospective cohort study was designed to investigate the estimated glomerular filtration rate (eGFR) in school-age children born with extremely low birthweight (ELBW) and to determine risk factors predictive of decreased eGFR. METHODS We compared eGFR based on cystatin C (CysC-eGFR) between school-age children born with ELBW (ELBW group, n = 48; median gestational age: 26.9 weeks; median birthweight: 792 g) and children born at term (control group, n = 48). The ELBW group was then further divided into a decreased CysC-eGFR subgroup (eGFR <90 mL/min per 1.73 m2 , n = 20) and a normal CysC-eGFR subgroup (n = 28), and perinatal background factors were compared. RESULTS The ELBW group showed a significantly lower CysC-eGFR compared with the control group (P < 0.001). Comparison between the decreased and normal CysC-eGFR subgroups in the ELBW group showed that children with lower birthweight, shorter gestational age, lower 5-min Apgar score, longer length of mechanical ventilation, lower weight gain in the first 11 weeks, chronic lung disease, and postnatal corticosteroid administration had significantly decreased CysC-eGFR. Multivariate logistic regression showed that a lower 5-min Apgar score was the only independent risk factor for decreased CysC-eGFR. CONCLUSIONS CysC-eGFR might already be decreased at school age in children born with ELBW. Renal assessment in regular follow-up examinations is recommended.
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Affiliation(s)
- Natsumi Yamamura-Miyazaki
- Department of Pediatric Nephrology and Metabolism, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Katsusuke Yamamoto
- Department of Pediatric Nephrology and Metabolism, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Kaori Fujiwara
- Department of Pediatric Nephrology and Metabolism, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Yoko Santo
- Department of Pediatric Nephrology and Metabolism, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Toshimi Michigami
- Department of Pediatric Nephrology and Metabolism, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan.,Department of Bone and Mineral Research, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Hiroyuki Kitajima
- Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
| | - Kenichi Satomura
- Department of Pediatric Nephrology and Metabolism, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Japan
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Mansuri A, Elmaghrabi A, Alhamoud I, Legan SK, Gattineni J, Baum M. Transient enalapril attenuates the reduction in glomerular filtration rate in prenatally programmed rats. Physiol Rep 2018; 5:5/8/e13266. [PMID: 28438986 PMCID: PMC5408291 DOI: 10.14814/phy2.13266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/04/2017] [Indexed: 01/09/2023] Open
Abstract
A maternal low‐protein diet has been shown to program hypertension and a reduction in glomerular filtration rate in adult offspring. This study examined the effect of continuous administration of enalapril in the drinking water and transient administration of enalapril administered from 21 to 42 days of age on blood pressure and glomerular filtration rate (GFR) in male rats whose mothers were fed a 20% protein diet (control) or a 6% protein diet (programmed) during the last half of pregnancy. After birth all rats were fed a 20% protein diet. Programmed rats (maternal 6% protein diet) were hypertensive at 15 months of age compared to control rats and both continuous and transient administration of enalapril had no effect on blood pressure on control offspring, but normalized the blood pressure of programmed offspring. GFR was 3.2 ± 0.1 mL/min in the control group and 1.7 ± 0.1 mL/min in the programmed rats at 17 months of age (P < 0.001). The GFR was 3.0 ± 0.1 mL/min in the control and 2.7 ± 0.1 mL/min in the programmed group that received continuous enalapril in their drinking water showing that enalapril can prevent the decrease in GFR in programmed rats. Transient administration of enalapril had no effect on GFR in the control group (3.2 ± 0.1 mL/min) and prevented the decrease in GFR in the programmed group (2.9 ± 0.1 mL/min). In conclusion, transient exposure to enalapril for 3 weeks after weaning can prevent the hypertension and decrease in GFR in prenatal programmed rats.
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Affiliation(s)
- Asifhusen Mansuri
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Ayah Elmaghrabi
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Issa Alhamoud
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Susan K Legan
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Jyothsna Gattineni
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Michel Baum
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas .,Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
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Conti G, De Vivo D, Fede C, Arasi S, Alibrandi A, Chimenz R, Santoro D. Low birth weight is a conditioning factor for podocyte alteration and steroid dependance in children with nephrotic syndrome. J Nephrol 2018; 31:411-415. [PMID: 29350347 DOI: 10.1007/s40620-018-0473-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Low birth weight (LBW) is associated with reduced nephron endowment. Clinical-pathologic features of post adaptive focal segmental glomerulosclerosis (FSGS) have been observed in subjects with prematurity and very LBW. METHODS We aimed to investigate the correlation between LBW and outcome in a cohort of 89 children with idiopathic nephrotic syndrome (NS) (2-12 years-old at onset, followed for > 3 years), of whom 21 with LBW (birth weight < 10th percentile for gestational age, gender, ethnicity, and maternal parity or birth weight < 2500 g). RESULTS Children with NS and LBW were found to have FSGS more frequently than children with normal birth weight (NBW) [8/21 = 38% vs. 4/68 = 6%; odds ratio, OR 7.754 (95% confidence interval, CI 2.184-27.525); χ2 = 9.817; p < 0.003]. Children with LBW and cortico-sensitive NS had a greater risk of cortico-dependence (CD) than those with NBW [10/13 = 76.9% vs. 28/63 = 44.4%, OR 4.744 (1.188-18.936); χ2 = 4.158; p < 0.05]. Moreover, children with LBW and CDNS needed a greater dose of immunosuppressive drugs than those with NBW [OR 4 (1.153-13.877); χ2 = 3.842; p = 0.05]. CONCLUSIONS LBW children developing NS had higher risk of FSGS and CD, and needed heavier immunosuppressive therapy than those with NBW. These data might suggest a conditioning role for hemodynamic and podocyte changes due to reduced nephron mass in LBW.
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Affiliation(s)
- Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU G. Martino, University of Messina, Messina, Italy.
| | - Dominique De Vivo
- Pediatric Nephrology and Rheumatology Unit, AOU G. Martino, University of Messina, Messina, Italy
| | - Claudia Fede
- Pediatric Nephrology and Rheumatology Unit, AOU G. Martino, University of Messina, Messina, Italy
| | - Stefania Arasi
- Pediatric Nephrology and Rheumatology Unit, AOU G. Martino, University of Messina, Messina, Italy
| | - Angela Alibrandi
- Department of Economical, Business and Environmental Sciences and Quantitative Methods, University of Messina, Messina, Italy
| | - Roberto Chimenz
- Pediatric Nephrology and Rheumatology Unit, AOU G. Martino, University of Messina, Messina, Italy
| | - Domenico Santoro
- Dialysis and Nephrology Unit, University of Messina, Messina, Italy
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71
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Diehm CJ, Lumbers ER, Weatherall L, Keogh L, Eades S, Brown A, Smith R, Johnson V, Pringle KG, Rae KM. Assessment of Fetal Kidney Growth and Birth Weight in an Indigenous Australian Cohort. Front Physiol 2018; 8:1129. [PMID: 29379446 PMCID: PMC5770802 DOI: 10.3389/fphys.2017.01129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/20/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction: Indigenous Australians experience higher rates of renal disease and hypertension than non-Indigenous Australians. Low birth weight is recognized as a contributing factor in chronic disease and has been shown to increase the risk of renal failure in adulthood. A smaller kidney volume with fewer nephrons places an individual at risk of hypertension and renal failure. Indigenous Australians have fewer nephrons than non-Indigenous Australians. In this study, intrauterine fetal and kidney growth were evaluated in 174 Indigenous Australian babies throughout gestation in order to record and evaluate fetal growth and kidney size, within a population that is at high risk for chronic illness. Methods: Pregnant women that identified as Indigenous, or non-Indigenous women that were pregnant with a partner who identified as an Indigenous Australian were eligible to participate. Maternal history, smoking status, blood and urine samples and fetal ultrasounds were collected throughout pregnancy. Fetal kidney measurements were collected using ultrasound. Statistical analysis was performed using the Stata 14.1 software package. Results: 15.2% of babies were born prematurely. 44% of the mothers reported smoking in pregnancy. The median birth weight of this cohort was 3,240 g. Male fetuses had higher kidney to body weight ratios than female fetuses (P = 0.02). The birth weights of term neonates whose mothers smoked during pregnancy were lower (327 g, P < 0.001) than the birth weights of term babies from non-smoking mothers. The kidney volumes of babies whose mothers smoked were also smaller (P = 0.02), but were in proportion to body weight. Conclusion: In this cohort of Indigenous women smoking was associated with both increased number of preterm births and with a reduction in birth weights, even of term infants. Since kidney volume is a surrogate measure of nephron number and nephrogenesis is complete at birth, babies whose mothers smoked during pregnancy must have fewer nephrons than those from non-smoking mothers. Previous studies have shown that glomerular filtration rate is not related to birth weight, thus infants with smaller kidney volumes are hyperfiltering from birth and therefore are likely to be more susceptible to early onset renal disease in later life.
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Affiliation(s)
- Christopher J Diehm
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia.,Department of Rural Health, University of Newcastle, Tamworth, NSW, Australia
| | - Eugenie R Lumbers
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia.,Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Loretta Weatherall
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Lyniece Keogh
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Sandra Eades
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Alex Brown
- Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Roger Smith
- Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Vanessa Johnson
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Kirsty G Pringle
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia.,Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Kym M Rae
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia.,Department of Rural Health, University of Newcastle, Tamworth, NSW, Australia
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Abstract
Chronic kidney disease affects more than 10% of the population. Programming studies have examined the interrelationship between environmental factors in early life and differences in morbidity and mortality between individuals. A number of important principles has been identified, namely permanent structural modifications of organs and cells, long-lasting adjustments of endocrine regulatory circuits, as well as altered gene transcription. Risk factors include intrauterine deficiencies by disturbed placental function or maternal malnutrition, prematurity, intrauterine and postnatal stress, intrauterine and postnatal overnutrition, as well as dietary dysbalances in postnatal life. This mini-review discusses critical developmental periods and long-term sequelae of renal programming in humans and presents studies examining the underlying mechanisms as well as interventional approaches to "re-program" renal susceptibility toward disease. Clinical manifestations of programmed kidney disease include arterial hypertension, proteinuria, aggravation of inflammatory glomerular disease, and loss of kidney function. Nephron number, regulation of the renin-angiotensin-aldosterone system, renal sodium transport, vasomotor and endothelial function, myogenic response, and tubuloglomerular feedback have been identified as being vulnerable to environmental factors. Oxidative stress levels, metabolic pathways, including insulin, leptin, steroids, and arachidonic acid, DNA methylation, and histone configuration may be significantly altered by adverse environmental conditions. Studies on re-programming interventions focused on dietary or anti-oxidative approaches so far. Further studies that broaden our understanding of renal programming mechanisms are needed to ultimately develop preventive strategies. Targeted re-programming interventions in animal models focusing on known mechanisms will contribute to new concepts which finally will have to be translated to human application. Early nutritional concepts with specific modifications in macro- or micronutrients are among the most promising approaches to improve future renal health.
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Affiliation(s)
- Eva Nüsken
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jörg Dötsch
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kai-Dietrich Nüsken
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
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Brennan S, Schneider M, Watson D, Kandasamy Y, Rudd D. The renal parenchyma-evaluation of a novel ultrasound measurement to assess fetal renal development: protocol for an observational longitudinal study. BMJ Open 2017; 7:e019369. [PMID: 29288189 PMCID: PMC5770966 DOI: 10.1136/bmjopen-2017-019369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Disorders of fetal growth, such as intrauterine growth restriction (IUGR) and large for gestational age (LGA), have been found to have a profound effect on the development of the fetal kidney. Abnormal kidney development is associated with hypertension and chronic kidney disease later in life. This study will use a novel ultrasound measurement to assess the renal parenchymal growth and kidney arterial blood flow in the fetus to evaluate the development of the fetal kidneys and provide an indirect estimate of nephron number. Measurements in normally grown, IUGR and LGA fetuses will be compared to determine if changes in renal parenchymal growth can be detected in utero. METHODS AND ANALYSIS This longitudinal, prospective, observational study will be conducted over 12 months in the Ultrasound Department of the Townsville Hospital, Australia. The study will compare fetal renal parenchymal thickness (RPT) and renal artery Doppler flow between IUGR fetuses and appropriately grown fetuses, and LGA fetuses and appropriately grown fetuses between 16 and 40 weeks. The fetal RPT to renal volume ratio will also be compared, and correlations between RPT, renal parenchymal echogenicity, fetal Doppler indices and amniotic fluid levels will be analysed. ETHICS AND DISSEMINATION This study was approved by the Townsville Health District Human Research Ethics Committee. The study results will form part of a thesis and will be published in peer-reviewed journals and disseminated at international conferences.
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Affiliation(s)
- Sonja Brennan
- Ultrasound Department, The Townsville Hospital, Townsville, Queensland, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Michal Schneider
- Medical Imaging & Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - David Watson
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Obstetrics and Gynaecology, The Townsville Hospital, Townsville, Queensland, Australia
| | - Yogavijayan Kandasamy
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
- Department of Neonatology, The Townsville Hospital, Townsville, Queensland, Australia
- Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, Newcastle, Australia
| | - Donna Rudd
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
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Abstract
Early-life conditions influence organ growth patterns and their functions, as well as subsequent risk for non-communicable chronic diseases in later life. A limited number of studies have determined that in Bangladesh, kidney size relates to its function among children as a consequence of the maternal and postnatal conditions. The present study objectives were to determine early-life conditions in relation to childhood kidney size and to compare their influences on kidney function. The study was embedded in a population-based prospective cohort of 1067 full-term singleton live births followed from fetal life onward. Kidney volume was measured by ultrasound in children at the age of 4.5 years (range 45-64 months), and the estimated glomerular filtration rate (eGFR) was assessed at the age of 9 years (range 96-116 months). The mean (s.d.) kidney volume of children at 4.5 years was 64.2 (11.3) cm3, with a significant mean difference observed between low birth weight and normal birth weight children (P<0.001). The multivariable model showed, changes in status from low birth weight to normal birth weight children, with kidney volume increases of 2.92 cm3/m2, after adjusting for the child's age, sex, maternal age and early pregnancy body mass index, and socio-economic index variables. One-unit change in kidney volume (cm3/m2) improved the eGFR to 0.18 ml/min/1.73 m2. The eGFR in low birth weight children was 5.44 ml/min/1.73 m2 less than that in normal birth weight children after adjustments. Low birth weight leads to adverse effects on kidney size and function in children.
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75
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Zywicki M, Blohowiak SE, Magness RR, Segar JL, Kling PJ. Increasing fetal ovine number per gestation alters fetal plasma clinical chemistry values. Physiol Rep 2017; 4:4/16/e12905. [PMID: 27565903 PMCID: PMC5002913 DOI: 10.14814/phy2.12905] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/27/2016] [Indexed: 12/18/2022] Open
Abstract
Intrauterine growth restriction (IUGR) is interconnected with developmental programming of lifelong pathophysiology. IUGR is seen in human multifetal pregnancies, with stepwise rises in fetal numbers interfering with placental nutrient delivery. It remains unknown whether fetal blood analyses would reflect fetal nutrition, liver, and excretory function in the last trimester of human or ovine IUGR. In an ovine model, we hypothesized that fetal plasma biochemical values would reflect progressive placental, fetal liver, and fetal kidney dysfunction as the number of fetuses per gestation rose. To determine fetal plasma biochemical values in singleton, twin, triplet, and quadruplet/quintuplet ovine gestation, we investigated morphometric measures and comprehensive metabolic panels with nutritional measures, liver enzymes, and placental and fetal kidney excretory measures at gestational day (GD) 130 (90% gestation). As anticipated, placental dysfunction was supported by a stepwise fall in fetal weight, fetal plasma glucose, and triglyceride levels as fetal number per ewe rose. Fetal glucose and triglycerides were directly related to fetal weight. Plasma creatinine, reflecting fetal renal excretory function, and plasma cholesterol, reflecting placental excretory function, were inversely correlated with fetal weight. Progressive biochemical disturbances and growth restriction accompanied the rise in fetal number. Understanding the compensatory and adaptive responses of growth‐restricted fetuses at the biochemical level may help explain how metabolic pathways in growth restriction can be predetermined at birth. This physiological understanding is important for clinical care and generating interventional strategies to prevent altered developmental programming in multifetal gestation.
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Affiliation(s)
- Micaela Zywicki
- Departments of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Sharon E Blohowiak
- Departments of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Ronald R Magness
- Departments of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA Obstetrics and Gynecology Perinatal Research Laboratories, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jeffrey L Segar
- Department of Pediatrics, University of Iowa Children's Hospital, Iowa, IA, USA
| | - Pamela J Kling
- Departments of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
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Brennan S, Watson D, Rudd D, Schneider M, Kandasamy Y. Evaluation of fetal kidney growth using ultrasound: A systematic review. Eur J Radiol 2017; 96:55-64. [PMID: 29103476 DOI: 10.1016/j.ejrad.2017.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/06/2017] [Accepted: 09/22/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE To determine the role of ultrasound imaging in evaluating fetal kidney growth. METHODS MEDLINE, CINAHL and EMBASE databases were electronically searched for studies between 1996 and January 2017 and limited to English language. Studies were included if they reported on an ultrasound technique to assess fetal kidney growth and they were not a case report or case series. There was independent selection of studies by two reviewers in consensus with one other reviewer. Data were extracted by one reviewer in consensus with two other reviewers. RESULTS A total of 1785 articles were identified. The full text of 39 of these were assessed for eligibility for inclusion. Twenty-eight studies were then included in the review. Standard two dimensional (2D) fetal renal measurements are easy to perform, however, this review identified that most studies had some methodological limitations. The disadvantage with 2D and three dimensional (3D) fetal renal volumes are that they include the entire kidney and good reproducibility of 3D volumes has not yet been demonstrated. Currently there is limited research on fetal kidney growth in the setting of abnormal fetal growth. Research focussing directly on fetal kidney parenchyma and blood flow is scarce. CONCLUSIONS Some nomograms of 2D and 3D fetal kidney size and volume have been developed. Kidney length is the most popular single fetal kidney measurement; however, it does not seem to be a good indicator of growth. In IUGR fetuses, kidney length remained similar to appropriately grown fetuses whereas AP and TS dimensions were significantly decreased. New ultrasound techniques focusing on the parenchyma of the kidney and perfusion to the kidney should be explored as they may provide more meaningful information on kidney development in the fetus and future kidney function.
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Affiliation(s)
- Sonja Brennan
- Ultrasound Department, The Townsville Hospital, IMB 47 P.O. Box 670, Douglas, Townsville, Queensland, 4810, Australia; College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia.
| | - David Watson
- Department of Obstetrics and Gynaecology, The Townsville Hospital, IMB 85 P.O. Box 670, Townsville, Queensland 4810, Australia
| | - Donna Rudd
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, School of Primary And Allied Health Care, 10 Chancellors Way, Monash University, Clayton, Victoria 3800, Australia
| | - Yogavijayan Kandasamy
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland 4811, Australia; Department of Neonatology, The Townsville Hospital, IMB 51 P.O. Box 670, Townsville, Queensland 4810, Australia; Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle,University Drive, Callaghan, NSW 2308, Australia
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77
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Park B, Lee HA, Lee SH, Park BM, Park EA, Kim HS, Cho SJ, Park H. Association Between Serum Levels of Uric Acid and Blood Pressure Tracking in Childhood. Am J Hypertens 2017; 30:713-718. [PMID: 28338917 DOI: 10.1093/ajh/hpx037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/15/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Recent studies suggest that high levels of serum uric acid of very early life are a result of the in-utero environment and may lead to elevated blood pressure (BP) in adulthood. However, serum uric acid levels can change throughout life. We investigated the effect of serum uric acid levels in childhood on the BP tracking and analysed BP according to changes in serum uric acid levels in early life. METHODS A total of 449 children from the Ewha Birth and Growth Cohort study underwent at least 2 follow-up examinations. Data were collected across 3 check-up cycles. Serum uric acid levels, BP, and anthropometric characteristics were assessed at 3, 5, and 7 years of age. RESULTS Children with a serum uric acid level higher than the median values had significantly increased systolic BP (SBP) and diastolic BP at 3 years of age. Baseline serum uric acid levels measured at 3 years of age, significantly affected subsequent BP in the sex and body mass index adjusted longitudinal data analysis (P < 0.05). Considering the changing pattern of serum uric acid over time, subjects with high uric acid levels at both 3 and 5 years of age had the highest SBP at 7 years of age. CONCLUSIONS These findings suggest the importance of maintaining an adequate level of serum uric acids from the early life. Appropriate monitoring and intervention of uric acid levels in a high-risk group can reduce the risk of a future increased BP.
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Affiliation(s)
- Bohyun Park
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Hye Ah Lee
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sung Hee Lee
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Bo Mi Park
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Eun Ae Park
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Hae Soon Kim
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Su Jin Cho
- Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Hyesook Park
- Department of Preventive Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
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79
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Abstract
Intrauterine or fetal growth restriction (IUGR) is a major complication of pregnancy and leads to significant perinatal morbidities and mortality. Typically, induction of IUGR in animals involves the complete occlusion or ablation of vessels to the uterus or placenta, acutely impairing blood flow and fetal growth, usually with high fetal loss. We aimed to produce a model of reduced fetal growth in the spiny mouse with minimal fetal loss. At 27 days gestational age (term is 38-39 days), a piece of silastic tubing was placed around the left uterine artery to prevent the further increase of uterine blood flow with advancing gestation to induce IUGR (occluded). Controls were generated from sham surgeries without placement of the tubing. Dams were humanely euthanized at 37 days gestational age and all fetuses and placentas were weighed and collected. Of the 17 dams that underwent surgery, 15 carried their pregnancies to 37 days gestational age and 95% of fetuses survived to this time. The difference in fetal body weight between occluded and control was ~21% for fetuses in the left uterus side: there were no differences for fetuses in the right uterus side. Offspring from the occluded group had significantly lower brain, liver, lung, kidney and carcass weights compared with shams. Preventing the gestation-related increase of uterine blood flow induced significant growth restriction in the fetal spiny mouse, with minimal fetal loss. This technique could be readily adapted for other small animal.
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80
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Dortaj H, Anvari M, Yadegari M, Hosseini Sharifabad M, Abbasi Sarcheshmeh A. Stereological Survey of the Effect of Vitamin C on Neonatal Rat Kidney Tissue Treated With Acrylamide. ACTA ACUST UNITED AC 2017. [DOI: 10.30699/mmlj17.1.2.42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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81
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Nuyt AM, Lavoie JC, Mohamed I, Paquette K, Luu TM. Adult Consequences of Extremely Preterm Birth: Cardiovascular and Metabolic Diseases Risk Factors, Mechanisms, and Prevention Avenues. Clin Perinatol 2017; 44:315-332. [PMID: 28477663 DOI: 10.1016/j.clp.2017.01.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Extremely preterm babies are exposed to various sources of injury during critical stages of development. The extremely preterm infant faces premature transition to ex utero physiology and undergoes adaptive mechanisms that may be deleterious in the long term because of permanent alterations in organ structure and function. Perinatal events can also directly cause structural injury. These disturbances induce morphologic and functional changes in their organ systems that might heighten their risks for later adult chronic diseases. This review examines the pathophysiology of programming of long-term health and diseases after preterm birth and associated perinatal risk factors.
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Affiliation(s)
- Anne Monique Nuyt
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
| | - Jean-Claude Lavoie
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Department of Nutrition, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Ibrahim Mohamed
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Katryn Paquette
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Thuy Mai Luu
- Division of General Pediatrics, Department of Pediatrics, Faculty of Medicine, Research Center, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
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82
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Abstract
Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.
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83
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Bassareo PP, Marras AR, Cugusi L, Zedda AM, Mercuro G. The reasons why cardiologists should consider prematurity at birth and intrauterine growth retardation among risk factors. J Cardiovasc Med (Hagerstown) 2017; 17:323-9. [PMID: 26627499 DOI: 10.2459/jcm.0000000000000338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The survival percentage of infants born preterm has risen steadily worldwide thanks to the giant steps forward made in the field of perinatal (the period immediately after birth) and neonatal (the first 4 weeks of birth following delivery) medicine. However, prematurity at birth and consequent low birth weight still represent the major causes of neonatal morbidity and mortality. Infants born preterm are at high risk of developing neurological, ophthalmological, and gastrointestinal complications as well. Furthermore, extensive more recent epidemiological findings have demonstrated an increase in risk factors and a higher mortality rate due to cardiovascular causes in patients born preterm and/or with intrauterine growth restriction. The aim of this review is to provide scientific evidence about how the cardiovascular system may be negatively influenced by prematurity and by a low birth weight that should by rights be viewed as new cardiovascular risk factors. This condition is referred to as 'cardiovascular perinatal programming'. In the light of the above, an early, constant, and prolonged cardiovascular follow-up should be implemented in former preterm individuals.
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Affiliation(s)
- Pier P Bassareo
- Department of Medical Sciences 'M. Aresu', University of Cagliari, Cagliari, Italy
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84
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Paauw ND, van Rijn BB, Lely AT, Joles JA. Pregnancy as a critical window for blood pressure regulation in mother and child: programming and reprogramming. Acta Physiol (Oxf) 2017; 219:241-259. [PMID: 27124608 DOI: 10.1111/apha.12702] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 02/06/2016] [Accepted: 04/25/2016] [Indexed: 12/13/2022]
Abstract
Pregnancy is a critical time for long-term blood pressure regulation in both mother and child. Pregnancies complicated by placental insufficiency, resulting in pre-eclampsia and intrauterine growth restriction, are associated with a threefold increased risk of the mother to develop hypertension later in life. In addition, these complications create an adverse intrauterine environment, which programmes the foetus and the second generation to develop hypertension in adult life. Female offspring born to a pregnancy complicated by placental insufficiency are at risk for pregnancy complications during their own pregnancies as well, resulting in a vicious circle with programmed risk for hypertension passing from generation to generation. Here, we review the epidemiology and mechanisms leading to the altered programming of blood pressure trajectories after pregnancies complicated by placental insufficiency. Although the underlying mechanisms leading to hypertension remain the subject of investigation, several abnormalities in angiotensin sensitivity, sodium handling, sympathetic activity, endothelial function and metabolic pathways are found in the mother after exposure to placental insufficiency. In the child, epigenetic modifications and disrupted organ development play a crucial role in programming of hypertension. We emphasize that pregnancy can be viewed as a window of opportunity to improve long-term cardiovascular health of both mother and child, and outline potential gains expected of improved preconceptional, perinatal and post-natal care to reduce the development of hypertension and the burden of cardiovascular disease later in life. Perinatal therapies aimed at reprogramming hypertension are a promising strategy to break the vicious circle of intergenerational programming of hypertension.
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Affiliation(s)
- N. D. Paauw
- Department of Obstetrics; Wilhelmina Children's Hospital Birth Center; University Medical Center Utrecht; Utrecht the Netherlands
| | - B. B. van Rijn
- Department of Obstetrics; Wilhelmina Children's Hospital Birth Center; University Medical Center Utrecht; Utrecht the Netherlands
- Academic Unit of Human Development and Health; University of Southampton; Southampton UK
| | - A. T. Lely
- Department of Obstetrics; Wilhelmina Children's Hospital Birth Center; University Medical Center Utrecht; Utrecht the Netherlands
| | - J. A. Joles
- Department of Nephrology and Hypertension; University Medical Center Utrecht; Utrecht the Netherlands
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85
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Malamitsi-Puchner A, Briana DD, Kontara L, Boutsikou M, Baka S, Hassiakos D, Marmarinos A, Gourgiotis D. Serum Cystatin C in Pregnancies With Normal and Restricted Fetal Growth. Reprod Sci 2016; 14:37-42. [PMID: 17636214 DOI: 10.1177/1933719106298196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate circulating levels of cystatin C (an important endogenous marker of renal function) in mothers, fetuses, and neonates from intrauterine growth-restricted (IUGR; characterized by impaired nephrogenesis) and appropriate-for-gestational-age (AGA) pregnancies. Serum cystatin C levels were measured by enzyme immunoassay in 40 parturients and their 20 IUGR (<or=3rd customized centile, due to gestational pathology) and 20 AGA fetuses and neonates on postnatal day 1 (N1) and 4 (N4). Comparatively, creatinine and urea concentrations were determined in the same samples. Fetal cystatin C levels were higher in the AGA than the IUGR group (P = .001). In both groups, maternal cystatin C levels were lower than fetal (P < .001), N1 (P < .001), and N4 (P < .001) levels. Fetal levels were higher than N1 (P < .001) and N4 (P < .001), and N1 levels were higher than N4 (P = .007) ones. In both groups, no correlation existed between maternal and fetal levels, but positive correlations were found between cystatin C, creatinine, and urea levels in maternal and neonatal samples (in all cases, r >or= 0.376 and P <or= .045). Cystatin C levels did not correlate with gestational age and did not differ between males and females. Fetal cystatin C serum levels are lower in the IUGR group, significantly decrease after birth, and do not correlate with maternal levels in both groups. In addition, serum cystatin C levels positively correlate with respective creatinine and urea levels in the perinatal period.
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Affiliation(s)
- Ariadne Malamitsi-Puchner
- Neonatal Division, Second Department of Obstetrics and Gynecology, Athens University Medical School, Athens, Greece. @aias.gr
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86
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Wang YP, Chen X, Zhang ZK, Cui HY, Wang P, Wang Y. Increased renal apoptosis and reduced renin-angiotensin system in fetal growth restriction. J Renin Angiotensin Aldosterone Syst 2016; 17:17/3/1470320316654810. [PMID: 27534427 PMCID: PMC5843940 DOI: 10.1177/1470320316654810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 04/05/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of the study was to characterize changes in apoptosis and the renin-angiotensin system (RAS) in fetal growth restriction (FGR). MATERIALS AND METHOD Fetuses were collected from patients who visited our hospital to either terminate or abort their pregnancy. Kidneys of fetuses which suffered with FGR, (n=11) at gestational age of 33.4±0.5 weeks and those from non-FGR (n=12) at gestational age of 34.3±0.9 weeks were collected. TUNEL, Bax and Bcl-2 staining were examined. The number of nephrons was also counted. Both protein and mRNA levels of renin and angiotensinogen were analyzed. Ultrasound was applied to measure fetus parameters including biparietal diameter, head circumference, circumference of abdomen, and femur length. RESULTS The number of nephrons was positively correlated with fetal weight at termination. Kidneys in the FGR group presented more apoptotic cells than those in the non-FGR group. Renin and angiotensinogen both decreased in the FGR group. Ultrasound revealed that biparietal diameter, abdomen circumference, femur length, and birth weight were all reduced in the FGR group compared with the non-FGR group. Kidney size was also restricted in the FGR group as indicated by ultrasound. CONCLUSION Renal apoptosis might contribute to the reduction of nephrons, and ultrasound plays a vital role in early diagnosis of developmental origins of health and disease (DOHAD).
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Affiliation(s)
- Yan P Wang
- Department of Obstetrics, Tianjin Central Hospital of Gynecology and Obstetrics, China
| | - Xu Chen
- Department of Obstetrics, Tianjin Central Hospital of Gynecology and Obstetrics, China
| | - Zhi K Zhang
- Department of Obstetrics, Tianjin Central Hospital of Gynecology and Obstetrics, China
| | - Hong Y Cui
- Department of Obstetrics, Tianjin Central Hospital of Gynecology and Obstetrics, China
| | - Peng Wang
- Department of Obstetrics, Tianjin Central Hospital of Gynecology and Obstetrics, China
| | - Yue Wang
- Department of Obstetrics, Tianjin Central Hospital of Gynecology and Obstetrics, China
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Luque V, Closa-Monasterolo R, Escribano J, Ferré N. Early Programming by Protein Intake: The Effect of Protein on Adiposity Development and the Growth and Functionality of Vital Organs. Nutr Metab Insights 2016; 8:49-56. [PMID: 27013888 PMCID: PMC4803318 DOI: 10.4137/nmi.s29525] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 12/22/2022] Open
Abstract
This article reviews the role of protein intake on metabolic programming early in life. The observations that breastfeeding in infancy reduces the risk of being overweight and obese later in life and the differences in the protein content between formula milk and human milk have generated the early protein hypothesis. The present review focuses on a mechanistic approach to programmed adiposity and the growth and development of other organs by protein intake in infancy, which may be mediated by branched-chain amino acids, insulin, and insulin-like growth factor 1 via the mammalian target of rapamycin. Observational studies and clinical trials have shown that lowering the protein content in infant and follow-on formulas may reduce the risk of becoming obese later in life. The recent body of evidence is currently being translated into new policies. Therefore, the evolution of European regulatory laws and recommendations by expert panels on the protein content of infant and follow-on formulas are also reviewed. Research gaps, such as the critical window for programming adiposity by protein intake, testing formulas with modified amino acids, and the long-term consequences of differences in protein intake on organ functionality among well-nourished infants, have been identified.
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Affiliation(s)
- Veronica Luque
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain.; Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Ricardo Closa-Monasterolo
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain.; Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Joaquín Escribano
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain.; Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Natalia Ferré
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain
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88
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Hann BD, Baldelomar EJ, Charlton JR, Bennett KM. Measuring the intrarenal distribution of glomerular volumes from histological sections. Am J Physiol Renal Physiol 2016; 310:F1328-36. [PMID: 26984953 DOI: 10.1152/ajprenal.00382.2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 03/11/2016] [Indexed: 11/22/2022] Open
Abstract
Glomerular volume is an important metric reflecting glomerular filtration surface area within the kidney. Glomerular hypertrophy, or increased glomerular volume, may be an important marker for renal stress. Current stereological techniques report the average glomerular volume (AVglom) within the kidney. These techniques cannot assess the spatial or regional heterogeneity common in developing renal pathology. Here, we report a novel "unfolding" technique to measure the actual distribution of individual glomerular volumes in a kidney from the two-dimensional glomerulus profiles observed by optical microscopy. The unfolding technique was first developed and tested for accuracy with simulations and then applied to measure the number of glomeruli (Nglom), AVglom, and intrarenal distribution of individual glomerular volume (IVglom) in the oligosyndactyl (Os/(+)) mouse model compared with wild-type (WT) controls. The Os/(+) mice had fewer and larger glomeruli than WT mice: Nglom was 12,126 ± 1,658 (glomeruli/kidney) in the WT mice and 5,516 ± 899 in the Os/(+) mice; AVglom was 2.01 ± 0.28 × 10(-4) mm(3) for the WT mice and 3.47 ± 0.35 × 10(-4) mm(3) for the Os/(+) mice. Comparing the glomerular volume distributions in Os/(+) and WT kidneys, we observed that the Os/(+) distribution peaked at a higher value of IVglom than the WT distribution peak, and glomeruli with a radius greater than 55 μm were more prevalent in the Os/(+) mice (3.4 ± 1.6% of total glomeruli vs. 0.6 ± 1.2% in WT). Finally, the largest profiles were more commonly found in the juxtamedullary region. Unfolding is a novel stereological technique that provides a new quantitative view of glomerular volume distribution in the individual kidney.
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Affiliation(s)
- Bradley D Hann
- Department of Molecular Biosciences and Bioengineering, University of Hawaii at Manoa, Honolulu, Hawaii
| | | | - Jennifer R Charlton
- Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, Virginia; and
| | - Kevin M Bennett
- Department of Biology, University of Hawaii at Manoa, Honolulu, Hawaii
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89
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Tang XS, Shen Q, Chen J, Zha XL, Xu H. Maternal protein restriction reduces perlecan at mid-metanephrogenesis in rats. Nephrology (Carlton) 2016; 21:200-8. [PMID: 26246161 DOI: 10.1111/nep.12583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Xiao-Shan Tang
- Department of Nephrology and Rheumatology; Children's Hospital of Fudan University; Shanghai China
| | - Qian Shen
- Department of Nephrology and Rheumatology; Children's Hospital of Fudan University; Shanghai China
| | - Jing Chen
- Department of Nephrology and Rheumatology; Children's Hospital of Fudan University; Shanghai China
| | - Xi-Liang Zha
- Department of Biochemistry and Molecular Biology; Shanghai Medical College; Fudan University; Shanghai China
| | - Hong Xu
- Department of Nephrology and Rheumatology; Children's Hospital of Fudan University; Shanghai China
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90
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Bueters RRG, Jeronimus-Klaasen A, Maicas N, Florquin S, van den Heuvel LP, Schreuder MF. The Effects of Early Postnatal Diuretics Treatment on Kidney Development and Long-Term Kidney Function in Wistar Rats. Nephron Clin Pract 2016; 132:110-8. [PMID: 26807737 DOI: 10.1159/000442674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 10/30/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diuretics are administered to neonates to control fluid balance. We studied whether clinical doses affected kidney development and function and whether extrauterine growth retardation (EUGR) could be a modulator. METHODS Wistar rats were cross-fostered in normal food or food restricted litters at postnatal day (PND) 2 and treated daily with 0.9% NaCl, 5 mg/kg furosemide or 5 mg/kg hydrochlorothiazide (HCTZ) up to PND 8. Kidneys were evaluated on proliferation, apoptosis and a set of mRNA target genes at PND 8, glomerular- and glomerular generation count at PND 35, clinical pathology parameters at 3- and 9 months, neutrophil gelatinase-associated lipocalin at PND 8, 3 and 6 months, monthly blood pressure from 3 months onward and histopathology at study end. RESULTS Treatment with furosemide or HCTZ did not have relevant effects on measured parameters. EUGR resulted in lower body weight from day 3 onwards (-29% at weaning; p < 0.001, -10% at necropsy; p < 0.001), less glomerular generations (4.4 ± 0.32 vs. 5.0 ± 0.423; p = 0.025, males only), decreased glomerular numbers (27,861 ± 3,468 vs. 30,527 ± 4,096; p = 0.026), higher creatinine clearance (0.84 ± 0.1 vs. 0.77 ± 0.09 ml/min/kg; p = 0.047) at 3 months and lower plasma creatinine (25.7 ± 1.8 vs. 27.5 ± 2.8 µmol/l; p = 0.043) at 9 months. CONCLUSION Furosemide and HCTZ did not influence kidney development or function when administered in a clinically relevant dose to rat pups at a stage of ongoing nephrogenesis. EUGR led to impaired kidney development but did not modify furosemide or HCTZ findings.
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Affiliation(s)
- Ruud R G Bueters
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
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91
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Stojanovska V, Scherjon SA, Plösch T. Preeclampsia As Modulator of Offspring Health. Biol Reprod 2016; 94:53. [PMID: 26792940 DOI: 10.1095/biolreprod.115.135780] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 01/15/2016] [Indexed: 02/01/2023] Open
Abstract
A balanced intrauterine homeostasis during pregnancy is crucial for optimal growth and development of the fetus. The intrauterine environment is extremely vulnerable to multisystem pregnancy disorders such as preeclampsia, which can be triggered by various pathophysiological factors, such as angiogenic imbalance, immune responses, and inflammation. The fetus adapts to these conditions by a mechanism known as developmental programming that can lead to increased risk of chronic noncommunicable diseases in later life. This is shown in a substantial number of epidemiological studies that associate preeclampsia with increased onset of cardiovascular and metabolic diseases in the later life of the offspring. Furthermore, animal models based predominantly on one of the pathophysiological mechanism of preeclampsia, for example, angiogenic imbalance, immune response, or inflammation, do address the susceptibility of the preeclamptic offspring to increased maternal blood pressure and disrupted metabolic homeostasis. Accordingly, we extensively reviewed the latest research on the role of preeclampsia on the offspring's metabolism and cardiovascular phenotype. We conclude that future research on the pathophysiological changes during preeclampsia and methods to intervene in the harsh intrauterine environment will be essential for effective therapies.
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Affiliation(s)
- Violeta Stojanovska
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sicco A Scherjon
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
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92
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Barbati A, Cappuccini B, Aisa MC, Grasselli C, Zamarra M, Bini V, Bellomo G, Orlacchio A, Di Renzo GC. Increased Urinary Cystatin-C Levels Correlate with Reduced Renal Volumes in Neonates with Intrauterine Growth Restriction. Neonatology 2016; 109:154-60. [PMID: 26756983 DOI: 10.1159/000441273] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exposure to intrauterine growth retardation (IUGR) can have a negative impact on nephrogenesis resulting in limited fetal kidney development and supporting the hypothesis that IUGR represents a risk for renal function and long-term renal disease. Cystatin-C (Cys-C), a strong inhibitor of cysteine proteinases, is freely filtered by the kidney glomerulus and is reabsorbed by the tubules, where it is almost totally catabolized; what remains is subsequently eliminated in urine. In tubular diseases and in hyperfiltration conditions, it seems reasonable to postulate that Cys-C degradation would decrease, and consequently an increase in its urinary elimination would be observed. OBJECTIVES The aim of this study was to investigate the urinary excretion of Cys-C simultaneously with the assessment of renal volumes in adequate for gestational age (AGA) and IUGR neonates in order to identify its clinical value in IUGR. METHODS Urinary Cys-C levels were measured using the enzyme immunoassay DetectX® Human Cystatin C kit in IUGR and AGA neonates. Whole renal and renal cortex volumes were assessed with ultrasounds (Vocal II; Software, GE). RESULTS Urinary Cys-C levels in IUGR were significantly higher than those found in AGA and were negatively correlated to reduced whole renal and renal cortex volumes. CONCLUSIONS The increased levels of Cys-C in the urine of neonates with IUGR were significantly associated with reduced renal/renal cortex volumes, suggesting that Cys-C could be taken as a surrogate of nephron mass. It also could be used as an early biochemical marker to identify IUGR neonates at high risk of developing long-term renal disease and to select patients for monitoring during childhood.
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Affiliation(s)
- Antonella Barbati
- Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
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93
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High protein intake in neonatal period induces glomerular hypertrophy and sclerosis in adulthood in rats born with IUGR. Pediatr Res 2016; 79:22-6. [PMID: 26372514 DOI: 10.1038/pr.2015.176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 06/22/2015] [Indexed: 01/23/2023]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) and postnatal nutrition are risk factors for cardiovascular and renal diseases in both humans and animals. The long-term renal effects of protein intake early in life remain unknown. The objective was to evaluate the effects of a neonatal feeding with high protein (HP) milk on renal functions and structure in IUGR male rats. METHODS Maternal gestational low protein diet was used to produce IUGR. At day 5, IUGR pups were gastrostomized in the "pup-in-the cup" model and received either normal protein (NP) milk or HP (+50% protein content) milk until day 21. After weaning, the animals were fed the same standard diet. Renal functions and structure were assessed at postnatal day 18 (D18) and in adult offspring. RESULTS During the preweaning period, the postnatal weight gain between the two groups was unaffected. On D18, kidneys from HP offspring were heavier with significant glomerular hypertrophy (+40%, P < 0.05). HP diet was associated with significant proteinuria and glomerulosclerosis (+49%, P < 0.05). Glomerular number was unaltered. CONCLUSION Neonatal HP feeding following IUGR affects renal functions and structure at adulthood. These alterations may result from a single nephron glomerular hyperfiltration.
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94
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Jonker SS, Louey S. Endocrine and other physiologic modulators of perinatal cardiomyocyte endowment. J Endocrinol 2016; 228:R1-18. [PMID: 26432905 PMCID: PMC4677998 DOI: 10.1530/joe-15-0309] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 01/09/2023]
Abstract
Immature contractile cardiomyocytes proliferate to rapidly increase cell number, establishing cardiomyocyte endowment in the perinatal period. Developmental changes in cellular maturation, size and attrition further contribute to cardiac anatomy. These physiological processes occur concomitant with a changing hormonal environment as the fetus prepares itself for the transition to extrauterine life. There are complex interactions between endocrine, hemodynamic and nutritional regulators of cardiac development. Birth has been long assumed to be the trigger for major differences between the fetal and postnatal cardiomyocyte growth patterns, but investigations in normally growing sheep and rodents suggest this may not be entirely true; in sheep, these differences are initiated before birth, while in rodents they occur after birth. The aim of this review is to draw together our understanding of the temporal regulation of these signals and cardiomyocyte responses relative to birth. Further, we consider how these dynamics are altered in stressed and suboptimal intrauterine environments.
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Affiliation(s)
- S S Jonker
- Knight Cardiovascular Institute Center for Developmental HealthOregon Health and Science University, Portland, Oregon 97239, USA
| | - S Louey
- Knight Cardiovascular Institute Center for Developmental HealthOregon Health and Science University, Portland, Oregon 97239, USA
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95
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Programmierung durch intrauterine Mangelversorgung. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3420-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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96
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Olowu WA. Pre-treatment considerations in childhood hypertension due to chronic kidney disease. World J Nephrol 2015; 4:500-510. [PMID: 26558187 PMCID: PMC4635370 DOI: 10.5527/wjn.v4.i5.500] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/25/2015] [Accepted: 10/08/2015] [Indexed: 02/06/2023] Open
Abstract
Hypertension (HTN) develops very early in childhood chronic kidney disease (CKD). It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start anti-hypertensive medication when blood pressure (BP) is persistently > 90th percentile for age, gender, and height in non-dialyzing hypertensive children with CKD. HTN pathomechanism in CKD is multifactorial and complexly interwoven. The patient with CKD-associated HTN needs to be carefully evaluated for co-morbidities that frequently alter the course of the disease as successful treatment of HTN in CKD goes beyond life style modification and anti-hypertensive therapy alone. Chronic anaemia, volume overload, endothelial dysfunction, arterial media calcification, and metabolic derangements like secondary hyperparathyroidism, hyperphosphataemia, and calcitriol deficiency are a few co-morbidities that may cause or worsen HTN in CKD. It is important to know if the HTN is caused or made worse by the toxic effects of medications like erythropoietin, cyclosporine, tacrolimus, corticosteroids and non-steroidal anti-inflammatory drugs. Poor treatment response may be due to any of these co-morbidities and medications. A satisfactory hypertensive CKD outcome, therefore, depends very much on identifying and managing these co-morbid conditions and HTN promoting medications promptly and appropriately. This review attempts to point attention to factors that may affect successful treatment of the hypertensive CKD child and how to attain the desired therapeutic BP target.
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97
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Early life obesity and chronic kidney disease in later life. Pediatr Nephrol 2015; 30:1255-63. [PMID: 25145270 DOI: 10.1007/s00467-014-2922-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 04/23/2014] [Accepted: 07/17/2014] [Indexed: 12/16/2022]
Abstract
The prevalence of chronic kidney disease (CKD) has increased considerably with a parallel rise in the prevalence of obesity. It is now recognized that early life nutrition has life-long effects on the susceptibility of an individual to develop obesity, diabetes, cardiovascular disease and CKD. The kidney can be programmed by a number of intrauterine and neonatal insults. Low birth weight (LBW) is one of the most identifiable markers of a suboptimal prenatal environment, and the important intrarenal factors sensitive to programming events include decreased nephron number and altered control of the renin-angiotensin system (RAS). LBW complicated by accelerated catch-up growth is associated with an increased risk of obesity, hypertension and CKD in later life. High birth weight and exposure to maternal diabetes or obesity can enhance the risk for developing CKD in later life. Rapid postnatal growth per se may also contribute to the subsequent development of obesity and CKD regardless of birth weight and prenatal nutrition. Although the mechanisms of renal risks due to early life nutritional programming remain largely unknown, experimental and clinical studies suggest the burdening role of early life obesity in longstanding cardiovascular and renal diseases.
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98
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Roderick PJ, Jeffrey RF, Yuen HM, Godfrey KM, West J, Wright J. Smaller kidney size at birth in South Asians: findings from the Born in Bradford birth cohort study. Nephrol Dial Transplant 2015. [PMID: 26209714 DOI: 10.1093/ndt/gfv274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rates of advanced chronic kidney disease and renal replacement therapy are higher in South Asian than in white British populations. Low birth weight is also more frequent in South Asian populations and has been associated with increased risks of kidney disease, perhaps due to a reduced nephron endowment. METHODS Using ultrasound scans at 34 weeks of gestation, we measured fetal kidney dimensions (transverse and anteroposterior diameters, length and circumference) and derived volume in a random sample of 872 white British and 715 South Asian participants in the Born in Bradford cohort study. Kidney measurements were compared between ethnic groups. RESULTS Birth weight for gestational age at 40 weeks was 200 g less in South Asian babies compared with white British babies. The mean kidney volume for gestational age was 16% lower in South Asian than in white British babies [8.79 versus 10.45 cm(3), difference 1.66 cm(3) (95% confidence interval 1.40-1.93, P < 0.001)]. The difference was robust after adjustment for maternal age, socio-economic factors, marital status, body mass index, smoking and alcohol use in pregnancy, parity, baby's gender and birth weight for gestational age [adjusted difference 1.38 cm(3) (0.97-1.84), P < 0.001]. There were smaller reductions in other fetal measures. CONCLUSION South Asian babies have smaller kidneys compared with white British babies, even after adjusting for potential confounders including birth weight. This finding may contribute to increased risks of adult kidney disease in South Asian populations.
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Affiliation(s)
- Paul J Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Robin F Jeffrey
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Ho M Yuen
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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99
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Preterm Birth Is Associated with Higher Uric Acid Levels in Adolescents. J Pediatr 2015; 167:76-80. [PMID: 25868431 PMCID: PMC4485952 DOI: 10.1016/j.jpeds.2015.03.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/23/2015] [Accepted: 03/19/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare serum uric acid levels in adolescents born prematurely and adolescents born at term and to assess the correlation between serum uric acid and blood pressure (BP) in those born prematurely. STUDY DESIGN In this observational cohort study, 124 adolescents born prematurely and 44 adolescents born at term were studied at 14 years of age. Multivariate analyses were used to describe the relationship of premature birth to serum uric acid while adjusting for confounding variables. Pearson correlation was used to describe the relationship between uric acid and systolic BP among those born prematurely. RESULTS Adjusting for race, sex, maternal hypertension, and fetal growth, we found that preterm adolescents had greater serum uric acid levels than adolescents born at term (adjusted mean difference 0.46, 95% CI 0.10-0.81 mg/dL; 27.4, 6-48.2 μmol/L; P = .012). Among those born prematurely, uric acid was positively correlated with systolic BP (Pearson correlation coefficient: 0.29, 0.12-0.44; P = .0013). CONCLUSIONS Serum uric acid levels are greater in adolescents born prematurely than in those born at term, and this difference could contribute to greater BP among individuals born prematurely.
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100
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Zhang Z, Kris-Etherton PM, Hartman TJ. Birth weight and risk factors for cardiovascular disease and type 2 diabetes in US children and adolescents: 10 year results from NHANES. Matern Child Health J 2015; 18:1423-32. [PMID: 24241968 DOI: 10.1007/s10995-013-1382-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Previous studies have shown that birth weight and other birth characteristics may be associated with risk for type 2 diabetes and cardiovascular disease (CVD) later in life; however, results using large US national survey data are limited. Our goal was to determine the aforementioned associations using nationally representative data. We studied children and adolescents 6-15 years using data from the National Health and Nutrition Examination Survey cycles 2001-2010. Survey and examination data included demographic and early childhood characteristics, current health status, physical activity information, anthropometric measurements, dietary data (total energy, saturated fat, sodium, and sugar intakes), biomarkers related to selected risk factors of CVD [systolic blood pressure (SBP), plasma C-reactive protein (CRP) and lipid profiles], and type 2 diabetes [fasting glucose, insulin, and homeostasis model assessment (HOMA)]. Birth weight (proxy-reported) was inversely associated with SBP among girls; SBP levels increased 1.4 mmHg for each 1,000 g decrease in birth weight (p = 0.003) after controlling for potential confounders. Birth weight was not associated with levels of CRP or lipid profiles across the three racial groups. In addition, birth weight was inversely related to levels of fasting insulin and HOMA among non-Hispanic Whites; for each 1,000 g decrease in birth weight, fasting insulin levels increased 9.1% (p = 0.007) and HOMA scores increased 9.8% (p = 0.007). Birth weight was inversely associated with the levels of SBP, fasting insulin, and HOMA. These results support a role for birth weight, independent of the strong effects of current body weight status, in increasing risk for CVD and type 2 diabetes.
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Affiliation(s)
- Zhiying Zhang
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
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