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Vashishta N, Surapaneni V, Chawla S, Kapur G, Natarajan G. Association among prematurity (<30 weeks' gestational age), blood pressure, urinary albumin, calcium, and phosphate in early childhood. Pediatr Nephrol 2017; 32:1243-1250. [PMID: 28391546 DOI: 10.1007/s00467-017-3581-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a paucity of data on blood pressures (BP), urinary albumin, and mineral excretion in early childhood in contemporary cohorts of extremely low gestational age (GA) neonates. Our aim was to compare BPs and the urinary excretion of albumin, calcium, and phosphate in preterm and term-born cohorts in early childhood. METHODS This was a prospective observational study conducted at a single center, involving children <5 years age, born preterm (GA <30 weeks) or at term (≥37 weeks' GA). Urinary albumin (mg/L), calcium and phosphate levels indexed to creatinine (mg/dL), and BP were measured. RESULTS The median (IQR) follow-up age of our cohort (n = 106) was 30 (16-48) months. Preterm-born children (n = 55) had a significantly lower mean GA and birth weight and higher mean systolic, diastolic, and mean BPs, compared with term (n = 51) controls. A significantly higher proportion of preterm-born children weighed <10th centile and had systolic BP >95th centile at follow-up. Albumin and calcium excretion did not differ between the groups; median urine-phosphate creatinine ratios were higher in the preterm group. On logistic regression, lower GA and younger age at follow-up were significantly associated with an increased risk of systolic and diastolic BP above the 95th centile; male gender was associated with decreased risk of diastolic hypertension. CONCLUSIONS Even in early childhood, children born preterm had significantly elevated BP, compared with their term-born counterparts. Closer monitoring of BPs in this population may be warranted.
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Affiliation(s)
- Namrata Vashishta
- Division of Neonatology, Wayne State University, Detroit, MI, USA.,St. John Providence Hospital, Southfield, MI, USA
| | - Vidya Surapaneni
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA
| | - Sanjay Chawla
- Division of Neonatology, Wayne State University, Detroit, MI, USA
| | - Gaurav Kapur
- Division of Pediatric Nephrology, Wayne State University, Detroit, MI, USA
| | - Girija Natarajan
- Division of Neonatology, Wayne State University, Detroit, MI, USA. .,Division of Neonatology, Department of Pediatrics, Wayne State University, Children's Hospital of Michigan, 3901 Beaubien Blvd, Detroit, MI, 48201, USA.
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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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Bassareo PP, Fanos V, Mussap M, Flore G, Noto A, Puddu M, Saba L, Mercuro G. Urinary NGAL and hematic ADMA levels: an early sign of cardio-renal syndrome in young adults born preterm? J Matern Fetal Neonatal Med 2014; 26 Suppl 2:80-3. [PMID: 24059560 DOI: 10.3109/14767058.2013.829698] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prematurity at birth is a known risk factor for the development of an early chronic renal disease. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a well established biomarker of kidney injury, while high blood levels of asymmetric dimethylarginine (ADMA) are associated with the future development of adverse cardiovascular events and cardiac death. AIMS (1) to verify the presence of statistically significant differences between urinary NGAL and hematic ADMA levels in young adults born preterm at extremely low birth weight (<1000 g; ex-ELBW) and those of a control group of healthy adults born at term (C) (2) to seek correlations between NGAL and ADMA levels, which would indicate the presence of an early cardio-renal involvement in ex-ELBW. METHODS Twelve ex-ELBW subjects (six males and six female, mean age: 23.9 ± 3.2 years) were compared with 12 C (six males and six female). Urinary NGAL and hematic ADMA levels were assessed. RESULTS Urinary NGAL levels were higher in ex- ELBW subjects compared to C (p < 0.05), as well as hematic ADMA concentrations (p < 0.05). A statistically significant correlation was found between urinary NGAL and ADMA (r = -0.60, p < 0.04). CONCLUSIONS Our preliminary findings support the hypothesis that in ex-ELBW subjects the development of an early chronic kidney disease contributes towards inducing an increase in the atherosclerotic process and in the risk of future adverse cardiovascular events.
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Affiliation(s)
- Pier Paolo Bassareo
- Department of Medical Sciences "M. Aresu", University of Cagliari , Cagliari , Italy
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Abitbol CL, Rodriguez MM. The long-term renal and cardiovascular consequences of prematurity. Nat Rev Nephrol 2012; 8:265-74. [PMID: 22371245 DOI: 10.1038/nrneph.2012.38] [Citation(s) in RCA: 129] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Infants born prematurely at <37 weeks' gestation account for over 80% of infants weighing <2,500 g at birth-low birth weight (LBW) infants. This designation remains the surrogate marker for developmental origins of adult disease. Landmark studies spanning four decades have shown that individuals born with a LBW are more likely to develop cardiovascular and renal disease in later life, which is believed to be related to 'developmental programming' of such adult disease during vulnerable periods of growth in utero and in the early postnatal period. There has long been ambiguity regarding the distinction between infants with intrauterine growth restriction and preterm infants since both show a low nephron endowment that is associated with subsequent hypertension and chronic kidney disease. Knowledge is growing specific to the preterm infant and the developmental associations of being born preterm with the interruption of normal organogenesis relative to the vascular tree and kidney. Both systems develop by branching morphogenesis and interruptions lead to considerable deficits in their structure and function. These developmental aberrations can lead to endothelial dysfunction, hypertension, proteinuria and metabolic abnormalities that persist throughout life. This Review will examine the effect of preterm birth on the development of cardiovascular and kidney disease in later life and will also discuss potential early interventions to alter the progression of disease.
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Affiliation(s)
- Carolyn L Abitbol
- Division of Pediatric Nephrology, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, Miami, FL 33101, USA.
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Zaffanello M, Bassareo PP, Cataldi L, Antonucci R, Biban P, Fanos V. Long-term effects of neonatal drugs on the kidney. J Matern Fetal Neonatal Med 2011; 23 Suppl 3:87-9. [PMID: 20653340 DOI: 10.3109/14767058.2010.501156] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Several drugs have been shown to produce an adverse affect on kidneys, mainly when exposure occurred during active nephrogenesis (pregnancy or prematurity). Several experimental studies on drug-related renal injury have been done on animal models. Observational reports on early drug-related nephrotoxicity in humans are increasing. The investigations regard nephrotoxicity from antibiotics (particularly aminoglycosides), angiotensin-converting enzyme (ACE) inhibitors, non-steroidal anti-inflammatory drugs and antifungins. Few reports have been specifically on the long-term effects on kidneys of drugs given to newborns during active nephrogenesis. Most observations were targeted to investigate long-term renal effects of prematurity and intrauterine growth retardation (IUGR). Nephrotoxic medication taken during fetal life and during postnatal nephrogenesis could interfere with nephron generation contributing to a particular magnitude of damage. Such adjunctive damage could further increase the risk of renal failure in the adulthood of children born prematurely.
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Affiliation(s)
- Marco Zaffanello
- Section of Pediatrics, Department of Life and Reproduction Sciences, University of Verona, Piazzale L. Scuro 10, Verona, Italy.
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Edwards DRV, Romero R, Kusanovic JP, Hassan SS, Mazaki-Tovi S, Vaisbuch E, Kim CJ, Erez O, Chaiworapongsa T, Pearce BD, Bartlett J, Friel LA, Salisbury BA, Anant MK, Vovis GF, Lee MS, Gomez R, Behnke E, Oyarzun E, Tromp G, Menon R, Williams SM. Polymorphisms in maternal and fetal genes encoding for proteins involved in extracellular matrix metabolism alter the risk for small-for-gestational-age. J Matern Fetal Neonatal Med 2011; 24:362-80. [PMID: 20617897 PMCID: PMC3104673 DOI: 10.3109/14767058.2010.497572] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine the association between maternal and fetal genetic variants and small-for-gestational-age (SGA). METHODS A case-control study was conducted in patients with SGA neonates (530 maternal and 436 fetal) and controls (599 maternal and 628 fetal); 190 candidate genes and 775 SNPs were studied. Single-locus, multi-locus and haplotype association analyses were performed on maternal and fetal data with logistic regression, multifactor dimensionality reduction (MDR) analysis, and haplotype-based association with 2 and 3 marker sliding windows, respectively. Ingenuity pathway analysis (IPA) software was used to assess pathways that associate with SGA. RESULTS The most significant single-locus association in maternal data was with a SNP in tissue inhibitor of metalloproteinase 2 (TIMP2) (rs2277698 OR = 1.71, 95% CI [1.26-2.32], p = 0.0006) while in the fetus it was with a SNP in fibronectin 1 isoform 3 preproprotein (FN1) (rs3796123, OR = 1.46, 95% CI [1.20-1.78], p = 0.0001). Both SNPs were adjusted for potential confounders (maternal body mass index and fetal sex). Haplotype analyses resulted in associations in α 1 type I collagen preproprotein (COL1A1, rs1007086-rs2141279-rs17639446, global p = 0.006) in mothers and FN1 (rs2304573-rs1250204-rs1250215, global p = 0.045) in fetuses. Multi-locus analyses with MDR identified a two SNP model with maternal variants collagen type V α 2 (COL5A2) and plasminogen activator urokinase (PLAU) predicting SGA outcome correctly 59% of the time (p = 0.035). CONCLUSIONS Genetic variants in extracellular matrix-related genes showed significant single-locus association with SGA. These data are consistent with other studies that have observed elevated circulating fibronectin concentrations in association with increased risk of SGA. The present study supports the hypothesis that DNA variants can partially explain the risk of SGA in a cohort of Hispanic women.
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Affiliation(s)
- Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, Tennessee, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Shali Mazaki-Tovi
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Edi Vaisbuch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Chong Jai Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Wayne State University, Detroit, Michigan, USA
| | - Offer Erez
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | - Brad D. Pearce
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jacquelaine Bartlett
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee, USA
| | - Lara A. Friel
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA
| | | | | | | | | | - Ricardo Gomez
- CEDIP (Center for Perinatal Diagnosis and Research), Department of Obstetrics and Gynecology, Sotero del Rio Hospital, Santiago, Chile
- Department of Obstetrics and Gynecology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Ernesto Behnke
- CEDIP (Center for Perinatal Diagnosis and Research), Department of Obstetrics and Gynecology, Sotero del Rio Hospital, Santiago, Chile
| | - Enrique Oyarzun
- Department of Obstetrics and Gynecology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Gerard Tromp
- Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA
| | - Ramkumar Menon
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Scott M. Williams
- Center for Human Genetics Research, Vanderbilt University, Nashville, Tennessee, USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee, USA
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Zaffanello M, Brugnara M, Bruno C, Franchi B, Talamini G, Guidi G, Cataldi L, Biban P, Mella R, Fanos V. Renal function and volume of infants born with a very low birth-weight: a preliminary cross-sectional study. Acta Paediatr 2010; 99:1192-8. [PMID: 20337778 DOI: 10.1111/j.1651-2227.2010.01799.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The aim of our study was to compare the function and volumes of kidneys of very low birth-weight (VLBW) and of extremely low birth-weight (ELBW) infants at pre-school ages. PATIENTS AND METHODS We did a revision of the neonatal records of infants born in our hospital that weighed < or =1500 g at birth. The children were divided into two groups according to their weight at birth: ELBW (<1000 g) and VLBW (1000-1500 g). At the age of 5.7 +/- 1.4 years, the children underwent clinical, laboratory and ultrasound renal assessments. RESULTS Sixty-nine children fulfilled the requirements for the study. The rate of neonatal treatment with aminoglycosides was higher in ELBW preterms. Renal function parameters, i.e. estimated glomerular filtration rate and albuminuria, did not differ between the two groups of children. Urinary alpha1-microglobulin excretion was significantly higher and kidneys were significantly smaller in the ELBW group than in the VLBW group. CONCLUSION No impairment or differences in renal parameters were found in pre-school children born ELBW compared with those born with VLBW, except for differences in kidney volume, renal cortical thickness and urinary alpha1-microglobulin excretion. Thus, patients born with ELBW would require a longer follow-up period.
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Affiliation(s)
- M Zaffanello
- Department of Mother-Child and Biology-Genetics, University of Verona, Verona, Italy
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Pereira JA, Rondó PHC, Lemos JO, Pacheco de Souza JM, Dias RSC. The influence of birthweight on arterial blood pressure of children. Clin Nutr 2010; 29:337-40. [PMID: 20116146 DOI: 10.1016/j.clnu.2010.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 12/19/2009] [Accepted: 01/06/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS This study examined the relationship between birthweight and blood pressure in childhood. METHODS Prospective cohort study involving 472 Brazilian children ranging in age from 5 to 8 years. Birthweight, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), total cholesterol and fractions (LDL-c, HDL-c), and triglycerides were determined. Total cholesterol, LDL-c, HDL-c, and triglycerides were assessed by automated enzymatic methods. Blood pressure was measured with the HDI/Pulse Wave CR-2000 equipment. Multiple regression models were used to investigate the relationship between birthweight and SBP and DBP, controlling for the following variables: gender, age, BMI, total cholesterol, triglycerides, per capita income, and maternal education. RESULTS When adjusting for gender and BMI, we found a systolic blood pressure increase of 2.9 (95% CI=-5.33 to -0.56) mmHg per kilogram birthweight reduction. The unadjusted association was insignificant. CONCLUSION Our data suggest that low birthweight is one of the factors contributing to blood pressure elevation at early ages. A way to prevent these diseases is by implementing public policies focused on good nutrition and adequate prenatal care for pregnant women.
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Affiliation(s)
- Joilane A Pereira
- Department of Nutrition, School of Public Health, University of São Paulo, Avenida Dr Arnaldo 715, São Paulo, SP, CEP-01246-904, Brazil
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