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Low birth weight, but not postnatal weight gain, aggravates the course of nephrotic syndrome
Christian Plank1, Iris Ostreicher, Katalin Dittrich
1Department of Paediatrics, Kinder- and Jugendklinik, University of Erlangen-Nuremberg, Loschgestrasse 15, 91056 Erlangen, Germany. Christian.plank@kinder.imed.uni-erlangen.de
Insights
Babies born small for gestational age (SGA) face a higher risk of severe childhood kidney disease. Early rapid weight gain did not impact disease progression in this study.
Area of Science:
- Pediatric Nephrology
- Developmental Pediatrics
- Renal Disease Research
Background:
- Studies indicate small for gestational age (SGA) infants have increased risk for aggravated renal disease postnatally.
- Rapid infant weight gain may contribute to the development of later-life kidney conditions.
Purpose of the Study:
- To investigate the association between birth weight (specifically SGA status) and the course of idiopathic nephrotic syndrome in children.
- To determine if early-life weight gain influences the severity and progression of childhood idiopathic nephrotic syndrome.
Main Methods:
- Retrospective analysis of 62 children with idiopathic nephrotic syndrome treated between 1994 and 2004.
- Comparison of disease course, including steroid resistance and need for antihypertensive treatment, between SGA and appropriate for gestational age (AGA) children.
- Assessment of the impact of weight gain between birth and 24 months on disease outcomes.
Main Results:
- Six children were born SGA; four of these developed steroid-resistant nephrotic syndrome (P < 0.05).
- Eighty-three percent of SGA children required antihypertensive treatment, compared to 39% of AGA children (P = 0.07).
- Weight gain in the first 2 years of life did not correlate with the disease course in either group.
Conclusions:
- Former SGA children exhibit an aggravated course of idiopathic nephrotic syndrome.
- Birth weight status is a significant factor, while early weight gain does not appear to influence disease progression in idiopathic nephrotic syndrome.
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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