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Fetal growth restriction and acute kidney injury in children and young adults

Sidse Høyer1, Uffe Heide-Jørgensen1, Mette Nørgaard1

  • 1Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.

Kidney International
|July 23, 2026
PubMed

Insights

Infants born small for gestational age (SGA) face a higher risk of acute kidney injury (AKI) into adulthood, especially those with major birth defects. This highlights the need for vigilant kidney health monitoring in growth-restricted individuals.

Area of Science:

  • Pediatric Nephrology
  • Developmental Biology
  • Public Health

Background:

  • Fetal growth restriction is linked to reduced nephron endowment, increasing long-term kidney vulnerability.
  • The association between fetal growth restriction and acute kidney injury (AKI) beyond the neonatal period is not well-established.
  • Individuals with major birth defects may have heightened vulnerability due to impaired organ development.

Purpose of the Study:

  • To investigate the association between fetal growth restriction (small for gestational age) and the risk of AKI from infancy to early adulthood.
  • To examine this association in individuals with and without major birth defects.

Main Methods:

  • Nationwide, population-based cohort study in Denmark (August 1995 - February 2022).
  • Linked national health registers and laboratory data.
  • Defined AKI biochemically using plasma creatinine; categorized birth weight for gestational age (SGA, AGA, LGA).
  • Used Cox regression models stratified by major birth defects to calculate 25-year AKI risk and adjusted hazard ratios (aHRs).

Main Results:

  • The cohort included 585,624 individuals without birth defects and 21,900 with defects.
  • Among those without defects, SGA was associated with a higher AKI risk (aHR 1.20) compared to AGA.
  • Among those with defects, SGA showed a significantly higher AKI risk (aHR 1.45) compared to AGA, with overall AKI risks substantially elevated in this subgroup.

Conclusions:

  • Being born small for gestational age is associated with an increased risk of AKI throughout infancy and early adulthood.
  • This risk is particularly pronounced in individuals with major birth defects.
  • Increased clinical awareness and monitoring are recommended for growth-restricted individuals to protect kidney health.
Abstract

Keywords:
acute kidney injuryfetal growth restrictionkidney development

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