Abstract
The pathogenesis of nephrotic syndrome is unclear. We conducted a nationwide population-based cohort study to examine the associations between preterm births and subsequent development of NS. NS was defined as ≥ 3 records with ICD-9-CM codes for NS in hospital admission or outpatient clinic visits. To avoid secondary nephrotic syndrome or nephritis with nephrotic range proteinuria, especially IgA nephropathy, we excluded patients with associated codes. A total of 78,651 preterm infants (gestational age < 37 weeks) and 786,510 matched term infants born between 2004 and 2009 were enrolled and followed until 2016. In the unadjusted models, preterm births, maternal diabetes, and pregnancy induced hypertension were associated with subsequent NS. After adjustment, preterm births remained significantly associated with NS (p = 0.001). The risk of NS increased as the gestational age decreased (p for trend < 0.001). Among the NS population, preterm births were not associated with more complications (Hypertension: p = 0.19; Serious infections: p = 0.63, ESRD: p = 0.75) or a requirement for secondary immunosuppressants (p = 0.61). In conclusion, preterm births were associated with subsequent NS, where the risk increased as the gestational age decreased. Our study provides valuable information for future pathogenesis studies.
Highlights
The pathogenesis of nephrotic syndrome is unclear
2.7% were born at gestational age ≤ 28 weeks
We conducted a national population-based cohort study to examine the association between preterm birth and subsequent development of Nephrotic syndrome (NS)
Summary
We conducted a nationwide population-based cohort study to examine the associations between preterm births and subsequent development of NS. Preterm births were associated with subsequent NS, where the risk increased as the gestational age decreased. Regulatory T (Treg) cells have been demonstrated to play a role in minimal change nephropathy[4], and the numbers of Treg cells have been found to be reduced in patients with NS5 These data suggest that adaptive immune response dysfunction may play a role in NS pathogenesis. Some investigations revealed that among children with nephrotic syndrome, those born with low birth weight or premature births were associated with unfavorable clinical courses[11,12], the relationship between preterm birth and NS development remains unknown.
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