Abstract
Background: Premature birth is associated with decreased nephron number and an increased risk for chronic kidney disease (CKD). To inform the development of guidelines for kidney follow up of children born prematurely, we undertook a study of individuals born extremely preterm, with the aim of characterizing the prevalence and predictors of microalbuminuria, elevated blood pressure, and/or abnormal kidney volume in adolescence.Methods: Study participants (n = 42) were born before 28 weeks of gestation and were enrolled at birth in the Extremely Low Gestational Age Newborns (ELGAN) study. When participants were 15 years old, we obtained 2 manual blood pressures, a spot urine microalbumin measurement, and sonographic measurements of kidney length and volume.Results: Of the 42 participants, 60% were male, 52% were Caucasian (18% Hispanic), and 43% were African-American. Their median age was 15 (IQR 15, 15.3) years. In 33.3% of the cohort, blood pressure was elevated (>120/80 mmHg). Microalbuminuria (>30 mg/g) was present in 11.9% of the cohort, and kidney volume below the 10th percentile of normative data was present in 14%. Twenty-one (50%) of the sample had at least one kidney abnormality (microalbuminuria, elevated blood pressures, and/or kidney hypoplasia); these individuals were more likely to have experienced neonatal hypotension [55% vs. 17% among those with no kidney abnormality, p = 0.02].Conclusions: Half of adolescents in this subset of ELGAN cohort have at least one risk factor of kidney disease (reduced kidney volume, microalbuminuria, and/or elevated blood pressures) at 15 years of age. This study suggests the importance of monitoring kidney outcomes in children after extremely preterm birth, especially those with a history of neonatal hypotension.
Highlights
Pediatric chronic kidney disease (CKD) carries a mortality rate 1000-fold higher compared to the age-matched non-CKD population, yet the initial onset of CKD is asymptomatic, delaying diagnosis in pediatric patients [1]
The mean body mass index (BMI) percentile was at the 71st percentile for age and sex and
The most important finding from this study is that in a sample of adolescents born extremely preterm, 50% had one or more abnormalities associated with CKD
Summary
Pediatric chronic kidney disease (CKD) carries a mortality rate 1000-fold higher compared to the age-matched non-CKD population, yet the initial onset of CKD is asymptomatic, delaying diagnosis in pediatric patients [1]. Delay in early recognition of CKD is associated with more rapid disease progression and earlier mortality among patients with End Stage Kidney Disease (ESKD) [2, 3]. Harer et al demonstrated that nearly a quarter of very low birth weight infants had evidence of kidney dysfunction during early childhood and South et al found that adolescents with a history of prematurity had higher blood pressures and decreased kidney function compared to adolescents born at term [8, 9]. Premature birth is associated with decreased nephron number and an increased risk for chronic kidney disease (CKD). To inform the development of guidelines for kidney follow up of children born prematurely, we undertook a study of individuals born extremely preterm, with the aim of characterizing the prevalence and predictors of microalbuminuria, elevated blood pressure, and/or abnormal kidney volume in adolescence
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