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Published on: August 19, 2020
Very low birth weight is a risk factor for secondary focal segmental glomerulosclerosis
Jeffrey B Hodgin1, Majid Rasoulpour, Glen S Markowitz
1Department of Pathology, Columbia University, College of Physicians & Surgeons, New York, NY 10032, USA.
Insights
Very low birth weight (LBW) and prematurity are linked to secondary focal segmental glomerulosclerosis (FSGS) in adults. This risk factor is often overlooked by nephrologists, highlighting a gap in patient history assessment.
Area of Science:
- Nephrology
- Pediatrics
- Public Health
Background:
- Low birth weight (LBW) is a known risk factor for adult hypertension and chronic kidney disease.
- LBW is associated with altered kidney development, including reduced nephron endowment.
- The link between LBW and secondary focal segmental glomerulosclerosis (FSGS) has not been previously reported.
Purpose of the Study:
- To investigate the potential association between a history of very low birth weight (LBW) and prematurity with the development of secondary focal segmental glomerulosclerosis (FSGS).
- To describe the clinical and pathological findings in patients with secondary FSGS and a history of LBW.
Main Methods:
- Retrospective case series of six patients with clinical and pathological findings suggestive of secondary FSGS.
- Review of patient histories for prematurity and very low birth weight (LBW).
- Analysis of renal biopsy findings, including glomerular sclerosis, glomerulomegaly, and podocyte foot process effacement.
Main Results:
- Six patients (2 women, 4 men; mean age 32 years) with secondary FSGS and a history of prematurity (22-30 weeks gestation) and very LBW (mean 1054 g) were identified.
- Patients presented with proteinuria (mean 3.3 g/d) and impaired creatinine clearance (mean 89 cc/min), but not full nephrotic syndrome.
- Renal biopsies showed FSGS in a minority of glomeruli, characterized by perihilar lesions, glomerulomegaly, and mild podocyte foot process effacement, consistent with postadaptive FSGS.
Conclusions:
- Very low birth weight (LBW) and prematurity are significant risk factors that promote the development of secondary focal segmental glomerulosclerosis (FSGS).
- Adult nephrologists may underrecognize this risk factor due to infrequent collection of birth history.
- Emphasizing the importance of birth history in adult nephrology practice is crucial for identifying patients at risk for LBW-associated kidney disease.
Background And Objectives:
Low birth weight (LBW), resulting from intrauterine growth retardation (IUGR) or prematurity, is a risk factor for adult hypertension and chronic kidney disease. LBW is associated with reduced nephron endowment and increased glomerular volume; however, the development of secondary focal segmental glomerulosclerosis (FSGS) has not been reported previously.
Design, Setting, Participants & Measurements:
The authors describe six patients with clinical and pathologic findings suggesting a secondary form of FSGS, in whom a history of prematurity and very LBW was obtained. No other known causes of secondary FSGS were identified.
Results:
The cohort consisted of two women and four men with a mean age of 32 yr. Patients were born at 22 to 30 wk gestation with mean birth weight of 1054 g (range 450 to 1420 g). Mean 24-h urine protein was 3.3 g/d (range 1.3 to 6.0 g/d), mean creatinine clearance 89 cc/min (range 71 to 132 cc/min), mean creatinine 1.2 mg/dl (range 0.9 to 1.5 mg/dl), and mean serum albumin 4.1 g/dl (range 3.4 to 4.8 g/dl). No patient had full nephrotic syndrome. Renal biopsy revealed FSGS involving a minority (mean 8.8%) of glomeruli, with a predominance of perihilar lesions of sclerosis (five of six patients), glomerulomegaly (all six patients), and only mild foot process effacement (mean 32%), all features typical of postadaptive FSGS.
Conclusions:
Our findings support that very LBW and prematurity promote the development of secondary FSGS. Because birth history is often not obtained by adult nephrologists, this risk factor is likely to be underrecognized.
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