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Konopásek P, Skálová S, Sládková E, Pecková M, Flachsová E, Urbanová I, Laubová J, Samešová M, Dvořák P, Zieg J. Low Birth Weight is Associated with More Severe Course of Steroid-Sensitive Nephrotic Syndrome in Children, Multicentric Study. KLINISCHE PADIATRIE 2024. [PMID: 38320582 DOI: 10.1055/a-2227-4892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Several previous studies have reported a more severe course of nephrotic syndrome in children with low birth weight. PATIENTS Cohort of 223 children with idiopathic nephrotic syndrome. METHODS We aimed to investigate the association between course of nephrotic syndrome and low birth weight. Data from seven paediatric nephrology centres were used. RESULTS Children with low birth weight had 3.84 times higher odds for a more severe course of steroid-sensitive nephrotic syndrome (95% CI 1.20-17.22, P=0.041), and those with low birth weight and remission after 7 days had much higher odds for a more severe course of disease (OR 8.7). Low birth weight children had a longer time to remission (median 12 vs. 10 days, P=0.03). They had a higher need for steroid-sparing agents (OR for the same sex=3.26 [95% CI 1.17-11.62, P=0.039]), and the odds were even higher in females with low birth weight (OR 6.81). There was no evidence of an association either between low birth weight and focal segmental glomerulosclerosis or between low birth weight and steroid-resistant nephrotic syndrome. DISCUSSION We conducted the first multicentric study confirming the worse outcomes of children with NS and LBW and we found additional risk factors. CONCLUSIONS Low birth weight is associated with a more severe course of steroid-sensitive nephrotic syndrome, while being female and achieving remission after 7 days are additional risk factors.
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Affiliation(s)
- Patrik Konopásek
- Pediatric Nephrology, Motol University Hospital, Praha, Czech Republic
| | - Sylva Skálová
- Pediatrics, Fakultní Nemocnice Hradec Králové, Hradec Kralove, Czech Republic
| | - Eva Sládková
- Pediatrics, Fakultní nemocnice Plzeň, Plzen, Czech Republic
| | - Monika Pecková
- Institute of Applied Mathematics and Information Technologies, Univerzita Karlova Přírodovědecká fakulta, Praha, Czech Republic
| | - Eva Flachsová
- Pediatrics, Motol University Hospital, Praha, Czech Republic
| | | | - Jana Laubová
- Pediatrics, Univerzita Jana Evangelisty Purkyně v Ústí nad Labem, Usti nad Labem, Czech Republic
| | - Martina Samešová
- Pediatrics, Univerzita Jana Evangelisty Purkyně v Ústí nad Labem, Usti nad Labem, Czech Republic
| | - Pavel Dvořák
- Pediatrics, Všeobecná fakultní nemocnice v Praze, Praha, Czech Republic
| | - Jakub Zieg
- Department of Pediatrics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Prague, Czech Republic
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Chen CC, Yu T, Chou HH, Chiou YY, Kuo PL. Premature birth carries a higher risk of nephrotic syndrome: a cohort study. Sci Rep 2021; 11:20639. [PMID: 34667222 PMCID: PMC8526683 DOI: 10.1038/s41598-021-00164-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/06/2021] [Indexed: 11/09/2022] Open
Abstract
The pathogenesis of nephrotic syndrome is unclear. We conducted a nationwide population-based cohort study to examine the associations between preterm births and subsequent development of NS. NS was defined as ≥ 3 records with ICD-9-CM codes for NS in hospital admission or outpatient clinic visits. To avoid secondary nephrotic syndrome or nephritis with nephrotic range proteinuria, especially IgA nephropathy, we excluded patients with associated codes. A total of 78,651 preterm infants (gestational age < 37 weeks) and 786,510 matched term infants born between 2004 and 2009 were enrolled and followed until 2016. In the unadjusted models, preterm births, maternal diabetes, and pregnancy induced hypertension were associated with subsequent NS. After adjustment, preterm births remained significantly associated with NS (p = 0.001). The risk of NS increased as the gestational age decreased (p for trend < 0.001). Among the NS population, preterm births were not associated with more complications (Hypertension: p = 0.19; Serious infections: p = 0.63, ESRD: p = 0.75) or a requirement for secondary immunosuppressants (p = 0.61). In conclusion, preterm births were associated with subsequent NS, where the risk increased as the gestational age decreased. Our study provides valuable information for future pathogenesis studies.
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Affiliation(s)
- Chih-Chia Chen
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Pediatric Nephrology, Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd., Tainan, Taiwan
| | - Tsung Yu
- Department of Public Health, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hsu Chou
- Department of Pediatrics, Ditmanson Medical Foundation, Chiayi Christian Hospital, Chia-Yi City, Taiwan.,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
| | - Yuan-Yow Chiou
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan. .,Division of Pediatric Nephrology, Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd., Tainan, Taiwan.
| | - Pao-Lin Kuo
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Rd., Tainan, Taiwan.
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Konstantelos N, Banh T, Patel V, Vasilevska-Ristovska J, Borges K, Hussain-Shamsy N, Noone D, Hebert D, Radhakrishnan S, Licht CPB, Langlois V, Pearl RJ, Parekh RS. Association of low birth weight and prematurity with clinical outcomes of childhood nephrotic syndrome: a prospective cohort study. Pediatr Nephrol 2019; 34:1599-1605. [PMID: 30976899 DOI: 10.1007/s00467-019-04255-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/11/2019] [Accepted: 03/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Low birth weight (LBW)/prematurity have been proposed as risk factors for the development of kidney disease in adulthood. Whether there is an association between LBW/prematurity and poor renal outcomes in childhood onset nephrotic syndrome remains unknown. METHODS Children with nephrotic syndrome diagnosed between 1 and 18 years of age were followed prospectively from 1996 to 2016 at The Hospital for Sick Children (N = 377). LBW/prematurity was defined as birth weight < 2500 g or gestational age < 36 weeks. Normal birth weight (NBW) was defined as birth weight ≥ 2500 g. Measures evaluating clinical course of nephrotic syndrome include initial steroid-resistant nephrotic syndrome (SRNS), time to first relapse, and frequently relapsing nephrotic syndrome. Kaplan-Meier survival analysis, logistic regression, and Cox proportional hazards regression were used to determine the association of LBW/prematurity with clinical outcomes. RESULTS Median birth weights in LBW/premature (n = 46) and NBW (n = 331) children were 2098 g (interquartile range [IQR] 1700-2325 g) and 3317 g (IQR 2977-3685 g), respectively. Odds of having SRNS were 3.78 (95% confidence interval [CI] 1.28-11.21) times higher among LBW/premature children than NBW children. An 8% decrease in odds of developing SRNS was observed for every 100 g increase in birth weight (adjusted odds ratio [OR] 0.92; 95% CI 0.86-0.98). Median time to first relapse did not differ (hazard ratio [HR] 0.89; 95% CI 0.53-1.16). CONCLUSIONS LBW/premature children were more likely to develop SRNS but did not have a difference in time to first relapse with NBW children. Understanding the impact and mechanism of birth weight and steroid-resistant disease needs further study.
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Affiliation(s)
- Natalia Konstantelos
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada
| | - Tonny Banh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Viral Patel
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada
| | - Jovanka Vasilevska-Ristovska
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Karlota Borges
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | | | - Damien Noone
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada
- Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Diane Hebert
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada
- Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Seetha Radhakrishnan
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada
- Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Christoph P B Licht
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada
- Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Valerie Langlois
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada
- Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Rachel J Pearl
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada
- Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
- Department of Pediatrics, William Osler Health System, 101 Humber College Blvd, Etobicoke, ON, M9V 1R8, Canada
| | - Rulan S Parekh
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada.
- Division of Nephrology, Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
- University Health Network, 101 College St, Toronto, ON, M5G 1L7, Canada.
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
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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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5
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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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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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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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Flynn JT, Ng DK, Chan GJ, Samuels J, Furth S, Warady B, Greenbaum LA. The effect of abnormal birth history on ambulatory blood pressure and disease progression in children with chronic kidney disease. J Pediatr 2014; 165:154-162.e1. [PMID: 24698454 PMCID: PMC4074552 DOI: 10.1016/j.jpeds.2014.02.051] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 01/13/2014] [Accepted: 02/20/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the associations between abnormal birth history (birth weight <2500 g, gestational age <36 weeks, or small for gestational age), blood pressure (BP), and renal function among 332 participants (97 with abnormal and 235 with normal birth history) in the Chronic Kidney Disease in Children Study, a cohort of children with chronic kidney disease (CKD). STUDY DESIGN Casual and 24-hour ambulatory BP were obtained. Glomerular filtration rate (GFR) was determined by iohexol disappearance. Confounders (birth and maternal characteristics, socioeconomic status) were used to generate predicted probabilities of abnormal birth history for propensity score matching. Weighted linear and logistic regression models with adjustment for quintiles of propensity scores and CKD diagnosis were used to assess the impact of birth history on BP and GFR. RESULTS Age at enrollment, percent with glomerular disease, and baseline GFR were similar between the groups. Those with abnormal birth history were more likely to be female, of Black race or Hispanic ethnicity, to have low household income, or part of a multiple birth. Unadjusted BP measurements, baseline GFR, and change in GFR did not differ significantly between the groups; no differences were seen after adjusting for confounders by propensity score matching. CONCLUSIONS Abnormal birth history does not appear to have exerted a significant influence on BP or GFR in this cohort of children with CKD. The absence of an observed association is likely secondary to the dominant effects of underlying CKD and its treatment.
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Affiliation(s)
- Joseph T Flynn
- Division of Nephrology, Seattle Children's Hospital, and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
| | - Derek K Ng
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Grace J Chan
- Division of Medicine Critical Care, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Joshua Samuels
- Division of Pediatric Nephrology and Hypertension, Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX
| | - Susan Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - Bradley Warady
- Division of Nephrology, Children's Mercy Hospital: Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO
| | - Larry A. Greenbaum
- Division of Pediatric Nephrology, Children's Healthcare of Atlanta; Department of Pediatrics, Emory University, Atlanta, GA
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Fetale und perinatale Programmierung der Nierenfunktion. GYNAKOLOGISCHE ENDOKRINOLOGIE 2014. [DOI: 10.1007/s10304-013-0593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Ikezumi Y, Suzuki T, Karasawa T, Yamada T, Hasegawa H, Nishimura H, Uchiyama M. Low birthweight and premature birth are risk factors for podocytopenia and focal segmental glomerulosclerosis. Am J Nephrol 2013; 38:149-57. [PMID: 23920104 DOI: 10.1159/000353898] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 06/20/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Recent reports suggest that low birthweight (LBW) is a risk factor for kidney diseases, including focal segmental glomerulosclerosis (FSGS), although the underlying pathological mechanism remains unknown. Podocyte loss triggers glomerulosclerosis; however, whether FSGS in LBW children is associated with podocytopenia is unclear. METHODS We reviewed the birthweights and gestational age of all patients who underwent renal biopsies from 1995 to 2011 at our Institute. Sixteen patients had FSGS, of which 6 (37.5%) had LBW; this LBW rate was significantly higher than the overall LBW rate in Japan (9.7%). The incidence of LBW was also high in patients with minimal change nephrotic syndrome (MCNS; 12.5%). The glomerular cell numbers in biopsy sections were calculated using computer image analysis and compared with FSGS of normal birthweight (NBW-FSGS). Biopsy specimens from age-matched patients with MCNS were also compared. Wilms' tumor-1 (WT1) immunohistochemistry was performed to enumerate the podocytes. RESULTS All patients in the LBW-FSGS group were also preterm, with an average gestational age of 25.8 weeks. The number of podocytes per glomerulus in the LBW-FSGS patients was 34 and 24% lower as compared to that in the MCNS patients (p < 0.01) and the NBW-FSGS patients (p < 0.05), respectively. Similar results were observed for the WT1-positive glomerular cell number. CONCLUSION LBW and premature birth were associated with FSGS development. The possibility that LBW and premature birth may be predisposing factors for severe podocytopenia in children with FSGS warrants further investigation.
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Affiliation(s)
- Yohei Ikezumi
- Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan.
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Dötsch J, Plank C, Amann K. Fetal programming of renal function. Pediatr Nephrol 2012; 27:513-20. [PMID: 21298502 DOI: 10.1007/s00467-011-1781-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 12/09/2010] [Accepted: 12/15/2010] [Indexed: 01/10/2023]
Abstract
Results from large epidemiological studies suggest a clear relation between low birth weight and adverse renal outcome evident as early as during childhood. Such adverse outcomes may include glomerular disease, hypertension, and renal failure and contribute to a phenomenon called fetal programming. Other factors potentially leading to an adverse renal outcome following fetal programming are maternal diabetes mellitus, smoking, salt overload, and use of glucocorticoids during pregnancy. However, clinical data on the latter are scarce. Here, we discuss potential underlying mechanisms of fetal programming, including reduced nephron number via diminished nephrogenesis and other renal (e.g., via the intrarenal renin-angiotensin-aldosterone system) and non-renal (e.g., changes in endothelial function) alterations. It appears likely that the outcomes of fetal programming may be influenced or modified postnatally, for example, by the amount of nutrients given at critical times.
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Affiliation(s)
- Jörg Dötsch
- Department of Pediatrics, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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12
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Benz K, Amann K. Maternal nutrition, low nephron number and arterial hypertension in later life. Biochim Biophys Acta Mol Basis Dis 2010; 1802:1309-17. [PMID: 20226855 DOI: 10.1016/j.bbadis.2010.03.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/30/2022]
Abstract
A potential role of the intrauterine environment in the development of low nephron number and hypertension in later life has been recently recognized in experimental studies and is also postulated in certain conditions in human beings. Nephrogenesis is influenced by genetic as well as by environmental and in particular maternal factors. In man nephrogenesis, i.e. the formation of nephrons during embryogenesis, takes place from weeks 5 to 36 of gestation with the most rapid phase of nephrogenesis occurring from the mid-2nd trimester until 36 weeks. This 16 week period is a very vulnerable phase where genetic and environmental factors such as maternal diet or medication could influence and disturb nephron formation leading to lower nephron number. Given a constant rise in body mass until adulthood lower nephron number may become "nephron underdosing" and result in maladaptive glomerular changes, i.e. glomerular hyperfiltration and glomerular enlargement. These maladaptive changes may then eventually lead to the development of glomerular and systemic hypertension and renal disease in later life. It is the purpose of this review to discuss the currently available experimental and clinical evidence for factors and mechanisms that could interfere with nephrogenesis with particular emphasis on maternal nutrition. In addition, we discuss the emerging concept of low nephron number being a new cardiovascular risk factor in particular for essential hypertension in later life.
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Affiliation(s)
- Kerstin Benz
- Department of Pediatric Nephrology, University of Erlangen-Nürnberg, Germany
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The implications of fetal programming of glomerular number and renal function. J Mol Med (Berl) 2009; 87:841-8. [PMID: 19652918 DOI: 10.1007/s00109-009-0507-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2009] [Revised: 07/15/2009] [Accepted: 07/15/2009] [Indexed: 12/26/2022]
Abstract
Large epidemiological studies suggest a clear relation between low birth weight and adverse renal outcomes evident as early as during childhood. Such adverse outcomes may include glomerular disease, hypertension, and renal failure. Data from autopsy material and from experimental models suggest that reduction in nephron number via diminished nephrogenesis may be a major mechanism, and factors that lead to this reduction are incompletely elucidated. Other mechanisms appear to be renal (e.g., via the intrarenal renin-angiotensin-aldosterone system) and nonrenal (e.g. changes in endothelial function). It also appears likely that the outcomes of fetal programming may be influenced postnatally, for example, by the amount of nutrients given at critical times.
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Plank C, Ostreicher I, Dittrich K, Waldherr R, Voigt M, Amann K, Rascher W, Dötsch J. Low birth weight, but not postnatal weight gain, aggravates the course of nephrotic syndrome. Pediatr Nephrol 2007; 22:1881-9. [PMID: 17874138 DOI: 10.1007/s00467-007-0597-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 07/16/2007] [Accepted: 07/16/2007] [Indexed: 01/21/2023]
Abstract
Clinical and animal studies have shown a higher risk of an aggravated course of renal disease in childhood after birth for babies small for gestational age (SGA). In addition relative "supernutrition" and fast weight gain in early infancy seem to support the development of later disease. In a retrospective analysis of 62 cases of idiopathic nephrotic syndrome treated between 1994 and 2004 at a university centre for paediatric nephrology, we related the course of disease to birth weight and to the weight gain in the first 2 years of life. Six children were born SGA (birth weight <-1.5 standard deviation score), and 56 were born as appropriate for gestational age (AGA). In all SGA children renal biopsy was performed, while only 55% of the AGA children underwent renal biopsy (P = 0.07), showing no difference in renal histology. In the SGA group, four of six patients developed steroid resistance (vs 12/56 AGA, P < 0.05). Of the SGA children, 83% needed antihypertensive treatment in the course of the disease compared to 39% of the AGA children (P = 0.07). The extent of weight gain between birth and 24 months of age did not influence the course of disease. In conclusion, we were able to find evidence for an aggravated course of idiopathic nephrotic syndrome in former SGA children. Independently of birth weight, weight gain in the first 2 years of life did not influence the course of disease.
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Affiliation(s)
- Christian Plank
- Department of Paediatrics, Kinder- and Jugendklinik, University of Erlangen-Nuremberg, Loschgestrasse 15, 91056 Erlangen, Germany.
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15
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Abstract
Depending on the definitions used, up to 10% of all live-born neonates are small for gestational age (SGA). Although the vast majority of these children show catch-up growth by 2 yr of age, one in 10 does not. It is increasingly recognized that those who are born SGA are at risk of developing metabolic disease later in life. Reduced fetal growth has been shown to be associated with an increased risk of insulin resistance, obesity, cardiovascular disease, and type 2 diabetes mellitus. The majority of pathology is seen in adults who show spontaneous catch-up growth as children. There is evidence to suggest that some of the metabolic consequences of intrauterine growth retardation in children born SGA can be mitigated by ensuring early appropriate catch-up growth, while avoiding excessive weight gain. Implicitly, this argument questions current infant formula feeding practices. The risk is less clear for individuals who do not show catch-up growth and who are treated with GH for short stature. Recent data, however, suggest that long-term treatment with GH does not increase the risk of type 2 diabetes mellitus and the metabolic syndrome in young adults born SGA.
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Affiliation(s)
- Paul Saenger
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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16
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Plank C, Ostreicher I, Hartner A, Marek I, Struwe FG, Amann K, Hilgers KF, Rascher W, Dötsch J. Intrauterine growth retardation aggravates the course of acute mesangioproliferative glomerulonephritis in the rat. Kidney Int 2006; 70:1974-82. [PMID: 17051140 DOI: 10.1038/sj.ki.5001966] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Intrauterine growth retardation (IUGR) aggravates the course of acute mesangioproliferative glomerulonephritis (GN) in the rat. Observational studies in children suggest that IUGR may be associated with a severe course of kidney diseases such as IgA nephropathy. We tested the hypothesis that IUGR leads to aggravation of acute mesangioproliferative GN in former IUGR rats. IUGR was induced in Wistar rats by isocaloric protein restriction in pregnant dams. Litter size was reduced to six male neonates in low protein animals (LP) and normal protein animals (NP). At 8 weeks GN was induced by injection of an anti-Thy-1.1 antibody. Rats were killed on days 4 and 14 after induction of GN and kidneys were investigated for inflammation and sclerosis using real-time polymerase chain reaction and histological methods. On day 4 after induction of GN, LP animals showed more glomerulosclerosis and tubulointerstitial lesions. On day 14, inflammatory markers (expression of monocyte chemoattractant protein 1, osteopontin, tumor necrosis factor and interleukin-6), extracellular matrix accumulation and markers of sclerosis (plasminogen activator inhibitor-1 expression, transforming growth factor-beta1 expression, score for glomerulosclerosis, glomerular deposition of collagen I and collagen IV) were more severe in LP animals. Some degree of induction of inflammatory and profibrotic markers was also present in non-nephritic LP animals. However, these rats did not display marked glomerulosclerosis or interstitial fibrosis. We conclude that after IUGR inflammatory damage is aggravated and the reparation of the kidney is impaired during the course of acute mesangioproliferative GN, leading to more sclerotic lesions.
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Affiliation(s)
- C Plank
- Department of Pediatrics and Adolescent Medicine, University Erlangen-Nuremberg, Erlangen, Germany.
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17
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Schreuder M, Delemarre-van de Waal H, van Wijk A. Consequences of Intrauterine Growth Restriction for the Kidney. Kidney Blood Press Res 2006; 29:108-25. [PMID: 16837795 DOI: 10.1159/000094538] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Low birth weight due to intrauterine growth restriction is associated with various diseases in adulthood, such as hypertension, cardiovascular disease, insulin resistance and end-stage renal disease. The purpose of this review is to describe the effects of intrauterine growth restriction on the kidney. Nephrogenesis requires a fine balance of many factors that can be disturbed by intrauterine growth restriction, leading to a low nephron endowment. The compensatory hyperfiltration in the remaining nephrons results in glomerular and systemic hypertension. Hyperfiltration is attributed to several factors, including the renin-angiotensin system (RAS), insulin-like growth factor (IGF-I) and nitric oxide. Data from human and animal studies are presented, and suggest a faltering IGF-I and an inhibited RAS in intrauterine growth restriction. Hyperfiltration makes the kidney more vulnerable during additional kidney disease, and is associated with glomerular damage and kidney failure in the long run. Animal studies have provided a possible therapy with blockage of the RAS at an early stage in order to prevent the compensatory glomerular hyperfiltration, but this is far from being applicable to humans. Research is needed to further unravel the effect of intrauterine growth restriction on the kidney.
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Affiliation(s)
- Michiel Schreuder
- Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
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18
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Jones SE, White KE, Flyvbjerg A, Marshall SM. The effect of intrauterine environment and low glomerular number on the histological changes in diabetic glomerulosclerosis. Diabetologia 2006; 49:191-9. [PMID: 16365725 DOI: 10.1007/s00125-005-0052-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Accepted: 08/21/2005] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS We tested the hypothesis that diabetic glomerulosclerosis would develop more rapidly in animals with fewer glomeruli. METHODS We studied the female offspring of Wistar rats that had been fed a low-protein diet (LPD) containing 6% protein or a normal-protein diet (NPD) containing 18% protein during pregnancy. Streptozotocin diabetes was induced at 12 weeks and animals were killed at 40 weeks. RESULTS Non-diabetic LPD offspring were of lower birthweight than the NPD offspring (5.19+/-0.64 vs 6.45+/-0.67 g, p<0.001) and had fewer glomeruli (27,402+/-3,137 vs 34,203+/-6,471, p<0.05). Glomerular volume correlated inversely with glomerular number (r=-0.64, p=0.035), but total glomerular filtration surface area was reduced in the LPD animals (4,770+/-541 vs 5,779+/-1,302 mm(2), p=0.05). Other renal structural and functional parameters were similar. In LPD and NPD diabetic animals, glomerular volume and basement membrane width were significantly increased compared to their respective controls. Podocyte density was lowest in the LPD diabetic animals (not significant), and the area covered by each podocyte was greater in the LPD diabetic group (2.40+/-0.693 x10(-3) mm(2)) than in the LPD control group (1.68+/-0.374 x10(-3) mm(2), p<0.001) and in the NPD diabetic animals (1.71+/-0.291 x 10(-3) mm(2), p<0.05). There was no difference in any other structural or functional parameter between the LPD and NPD diabetic animals. CONCLUSIONS/INTERPRETATION A decrease in glomerular number was not deleterious to renal structure and function over 40 weeks in this animal model. Further work in models with progressive renal impairment and hypertension is necessary to clarify the impact of glomerular number on the development of renal disease.
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Affiliation(s)
- S E Jones
- Diabetes Research Group, School of Clinical Medical Sciences, University Of Newcastle upon Tyne, Newcastle upon Tyne, UK
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19
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Schmidt IM, Chellakooty M, Boisen KA, Damgaard IN, Mau Kai C, Olgaard K, Main KM. Impaired kidney growth in low-birth-weight children: Distinct effects of maturity and weight for gestational age. Kidney Int 2005; 68:731-40. [PMID: 16014050 DOI: 10.1111/j.1523-1755.2005.00451.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) alters the regulation of calcium and phosphate homeostasis, leading to secondary hyperparathyroidism, metabolic bone disease, soft tissue calcifications, and other metabolic derangements that have a significant impact on morbidity and mortality. The parathyroid gland is the central organ responsible for regulating these adaptive responses. Suppression of parathyroid hormone (PTH) secretion, hypertrophy, and hyperplasia are a major goal of treatment of CKD. METHODS Current literature was reviewed and combined with the author's experience to address a number of issues regarding the optimal treatment of secondary hyperparathyroidism in hemodialysis patients. RESULTS The calcium sensing receptor (CASR) is the most important factor regulating parathyroid gland function, and allosteric modulators of CASR, called calcimimetics, provide a novel drug therapy to suppress PTH secretion. The current use of active vitamin D analogues to suppress PTH is often limited by hypercalcemia and hyperphosphatemia. Clinical trials of cinacalcet HCl, the first calcimimetic to be approved for treatment of secondary hyperparathyroidism in CKD, have demonstrated suppression of circulating PTH levels without increments in the calcium-phosphorus (Ca x P) product, making it easier to achieve the stringent management guidelines proposed for subjects with CKD by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI). CONCLUSION The management of disordered calcium and phosphate homeostasis in CKD patients is evolving based on our knowledge of the major importance of the calcium sensing receptor (CASR) in controlling parathyroid gland function and the potent actions of calcimimetics to target CASR. The purpose of this presentation is to provide an overview of the role of the CASR in regulation of parathyroid gland function, to examine the mechanisms whereby calcimimetics target the CASR, and to review the clinical trials that support the use of cinacalcet HCl for the treatment of secondary hyperparathyroidism in stage 5 chronic kidney disease (CKD).
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Affiliation(s)
- Ida M Schmidt
- University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.
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Abstract
There is accumulating evidence of the impact of low birth weight in adult age. Thus, the Barker theory and Brenner hypothesis gain more power. This article reviews and analyzes the evidence that supports the intrauterine origin of chronic noncommunicable diseases in adult age, particularly systemic arterial hypertension and chronic renal insufficiency. These are possibly related to lower nephron numbers, acquired in utero or later in life, which can increase susceptibility to kidney damage from diseases such as hypertension and diabetes mellitus, or cause arterial hypertension and secondary renal damage.
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Affiliation(s)
- Leonardo Reyes
- Instituto de Nefrología, Ave 26 y Boyeros, Apdo. 6358, Havana 10600, Cuba.
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Fakhouri F, Bocquet N, Taupin P, Presne C, Gagnadoux MF, Landais P, Lesavre P, Chauveau D, Knebelmann B, Broyer M, Grünfeld JP, Niaudet P. Steroid-sensitive nephrotic syndrome: from childhood to adulthood. Am J Kidney Dis 2003; 41:550-7. [PMID: 12612977 DOI: 10.1053/ajkd.2003.50116] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The clinical presentation, treatment, and outcome of steroid-sensitive nephrotic syndrome (SSNS) during childhood have been extensively studied. Conversely, few data regarding the outcome in adulthood of childhood SSNS have been published previously. We undertook to conduct a retrospective study of the outcome in adulthood of a large cohort of patients diagnosed with an SSNS during childhood. METHODS We identified all children born between 1970 and 1975 who had been admitted to our institution for an SSNS. Data regarding the outcome in adulthood of these patients were obtained through mailed questionnaires or phone calls to patients and/or their parents or through attending physicians. RESULTS One hundred seventeen patients were identified. Data regarding the outcome of SSNS in adulthood were available for 102 patients (87.2%). Forty-three patients (42.2%) experienced at least one relapse of nephrotic syndrome in adulthood. By univariate analysis, young age at onset (<6 years) and more severe disease in childhood, indicated by a greater number of relapses (12.9 for adulthood relapsers versus 5.4 for adulthood nonrelapsers; P < 0.0001) and more frequent use of immunosuppressors (74.4% versus 31.6%; P < 0.0001) or cyclosporine (42.9% versus 7.3%; P < 0.0001) were predictive of the occurrence of SSNS relapse in adulthood. Conversely, relapse rate in the first 6 months of disease was not predictive of further relapses in adulthood. By multivariate analysis, only number of relapses during childhood was predictive of adulthood relapses (P < 0.0058). Long-term side effects of steroids were found in 44.2% of adulthood relapsers; the most frequent were osteoporosis and excess weight. CONCLUSION The incidence of childhood SSNS relapses in adulthood was relatively high in our study. Further studies are required to assess long-term complications in adults with relapses and a history of prolonged steroid and immunosuppressor use.
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Affiliation(s)
- Fadi Fakhouri
- Department of Nephrology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France.
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