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Effect of intrauterine growth retardation on renal function on day one of life
D Robinson1, C P Weiner, K T Nakamura
1Perinatal Research Laboratory, University of Iowa Medical School, Iowa City 52242.
Insights
Fetal growth restriction impacts newborn kidney development, showing reduced glomerular filtration rate and higher sodium excretion in the first 24 hours of life. This suggests impaired renal maturation in growth-retarded neonates.
Area of Science:
- Neonatal Physiology
- Renal Function in Neonates
- Fetal Growth Restriction
Background:
- Fetal growth restriction (FGR) is a significant concern in neonatology.
- Understanding the impact of FGR on early renal development is crucial for long-term health outcomes.
- Maturation of renal function in the neonatal period is critical.
Purpose of the Study:
- To investigate the effect of fetal growth restriction on renal function in neonates during the first 24 hours of life.
- To compare glomerular filtration rate and sodium handling between growth-retarded and appropriately grown neonates.
- To explore potential factors influencing renal function, such as prostaglandin levels.
Main Methods:
- Measured inulin clearance (glomerular filtration rate) per kilogram in neonates.
- Assessed fractional sodium excretion per kilogram.
- Analyzed osmolality and urinary prostaglandin concentrations.
- Compared data between seven growth-retarded and six appropriately grown neonates matched for gestational age.
Main Results:
- Growth-retarded neonates showed a nonsignificant reduction in inulin clearance per kilogram (p = 0.11).
- Inulin clearance correlated with gestational age and birthweight in the growth-retarded group.
- Fractional sodium excretion was significantly higher in growth-retarded neonates (p < 0.05).
- Increased sodium excretion was not explained by blood pressure or fluid intake, but potentially by prostaglandin differences.
Conclusions:
- Fetal growth restriction is associated with impaired renal maturation in neonates.
- Manifestations include decreased glomerular filtration rate and increased sodium excretion within the first 24 hours of life.
- These findings highlight the vulnerability of the neonatal kidney to growth restriction.
Abstract:
We measured inulin clearance per kilogram, fractional sodium excretion per kilogram, osmolality, and urinary prostaglandin concentration in seven growth-retarded neonates and six appropriately grown neonates matched for gestational age during the first 24 hours of life to determine the effect of fetal growth retardation on renal function. There was a nonsignificant reduction in inulin clearance per kilogram in the growth-retarded neonates (p = 0.11). Inulin clearance correlated with gestational age in both groups. It was significantly correlated with birthweight in the growth-retarded group (p less than 0.05) but did not reach significance in the control group (p less than 0.06). Fractional sodium excretion was significantly higher in the growth-retarded fetuses (p less than 0.05). This increase was not explainable by differences in mean blood pressure and intravenous fluid intake, although differences in urinary prostaglandin concentrations during the study interval may be involved. In conclusion, we have demonstrated that growth retardation is associated with impaired renal maturation, which during the first 24 hours of life is manifest as decreased glomerular filtration rate and increased sodium excretion.