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Chronic kidney disease associated with extremely premature birth and extremely low birth weight may progress through

Chinatsu Onodera1, Ken Ishikawa2, Hiroshi Sugawara2

  • 1Department of Pediatrics, School of Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate Prefecture, 028-3694, Japan. chinaono@iwate-med.ac.jp.

CEN Case Reports
|October 5, 2024
PubMed

Insights

Infants born with low birth weight or prematurely may develop chronic kidney disease (CKD) later in life. Early monitoring after neonatal intensive care unit (NICU) discharge is crucial for detecting kidney damage in these high-risk infants.

Area of Science:

  • Pediatrics
  • Nephrology
  • Neonatology

Background:

  • Infants born with low birth weight and/or premature birth (L/P-CKD) may have fewer nephrons, increasing susceptibility to kidney injury.
  • Nephrotoxic exposures during early infancy can exacerbate kidney damage in these vulnerable infants.
  • The long-term progression of L/P-CKD remains poorly understood.

Purpose of the Study:

  • To present three cases of L/P-CKD diagnosed in adolescence after NICU discharge.
  • To highlight the potential long-term renal consequences in extremely premature and low birth weight infants.
  • To emphasize the need for extended follow-up protocols for these patients.

Main Methods:

  • Case series of three extremely premature infants (24-26 weeks gestation, 606-906g birth weight) requiring prolonged NICU stays (117-311 days).
  • Monitoring included serum creatinine, renal ultrasonography, and renal biopsy.
  • Clinical data reviewed for potential causes of kidney damage, excluding common factors like infections or lifestyle issues.

Main Results:

  • Patients developed proteinuria in adolescence (10-15 years) despite normal creatinine at NICU discharge.
  • Renal ultrasonography showed smaller-than-normal kidneys.
  • Renal biopsies revealed glomerulomegaly and perihilar glomerulosclerosis, suggesting glomerular hypertension.

Conclusions:

  • L/P-CKD can manifest in adolescence, indicated by proteinuria and specific renal biopsy findings.
  • The progression of CKD in these infants may be linked to growth spurts and delayed diagnosis.
  • Establishing long-term follow-up from NICU discharge through adulthood is essential for managing L/P-CKD.

Keywords:
Abnormal nephrogenesisChronic kidney diseaseExtremely premature birthFewer nephronsHyperfiltration theoryLow birth weight infants

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