Grand Rounds in Pediatric Nephrology – an ISN-IPNA Sister Centers initiative: Small kidneys at birth: implications into adulthood
- 2:00 PM CEST
It has been well recognized that individuals born with low birth weight, small for gestation age and/or delivered prematurely are at increased risk for the development of hypertension and chronic kidney disease (CKD). The basis of this risk is believed to be related to disruption of developmental programming leading to reduced nephron number.
Supportive measures and treatments that promote renal health and retard progression of CKD are broadly available. However, many individuals who are at-risk based upon their birth history do not receive adequate screening to permit early detection and intervention.
We will present the case of a teenager who was delivered both prematurely and at a very low birth weight and subsequently developed CKD and hypertension.
We will then review the relationship of abnormal birth history and subsequent kidney disease and hypertension. We will discuss the importance of identifying at-risk individuals and ensuring disease screening during childhood and adulthood. We will also discuss the opportunity to reduce the risk of preterm birth and abnormal intrauterine growth by optimizing maternal health, thereby reducing the burden of CKD globally
Learning objectives:
- Being born too early (preterm) or too small (small for gestational age) are risk factors for longer term hypertension, kidney disease, cardiovascular disease and pregnancy complications
- Preterm birth and being small for gestational age are associated with smaller kidneys with fewer nephrons.
- Being born with smaller kidneys constitutes a first kidney “hit” which enhances vulnerability further kidney “hits”
- Long-term follow up of at-risk infants is advised to permit early diagnosis, and intervention to prevent or delay kidney disease
- Addressing the Social Determinants of Health across the life course is important to reduce the cycle of risk
Further reading:
- Bianchi, M. E., & Restrepo, J. M. (2022). Low birthweight as a risk factor for non-communicable diseases in adults. Frontiers in medicine, 8, 793990.
- Iyengar, A., Nesargi, S., George, A., Sinha, N., Selvam, S., & Luyckx, V. A. (2016). Are low birth weight neonates at risk for suboptimal renal growth and function during infancy?. BMC nephrology, 17, 1-9.
- Luyckx, V. A., Shukha, K., & Brenner, B. M. (2011). Low nephron number and its clinical consequences. Rambam Maimonides medical journal, 2(4).
- Weight, The Low Birth, and Nephron Number Working Group. “The impact of kidney development on the life course: a consensus document for action.” Nephron. Clinical Practice 136.1 (2017): 3.
- Anna Gjerde et al. Intrauterine growth restriction and risk of diverse forms of kidney disease during the first 50 years of life. CJASN 2020.
Moderator
Rukshana Shroff (UK)
Speakers
Nancy Rodig (USA)
Valerie Luyckx (Switzerland)
Jaime Restrepo (Colombia)
Onex Ton-Aimé (Haiti)