Nephron and Podocyte Metrics in Adolescents With a History of Low Birth Weight: A Three-Case Report

Low birth weight (LBW), which is indicative of impaired fetal growth, is associated with the development of both nephrons and podocytes, increasing the risk of kidney disease later in life. However, the clinical evidence remains limited. We herein reported 3 patients with a history of LBW who developed overt proteinuria during adolescence. Using kidney biopsy samples from these patients, we conducted a comprehensive morphometric analysis of nephrons and podocytes. Compared with healthy and diseased kidney controls, all 3 cases exhibited a profoundly reduced number of nephrons, lower podocyte density, and pronounced hypertrophy of both glomeruli and podocytes. Lifestyle modifications and treatment with renin-angiotensin-aldosterone system inhibitors and/or sodium-glucose cotransporter 2 inhibitors led to a reduction in proteinuria but did not achieve complete remission. Our findings highlighted the limitations of current therapeutic strategies and emphasized the urgent need for early and targeted interventions in this high-risk population. An integrated approach that simultaneously evaluates nephrons and podocytes holds promise for advancing research and for enhancing clinical strategies for LBW individuals across diverse causes and life stages.