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Pediatric Nephrology

, Volume 22, Issue 11, pp 1881–1889 | Cite as

Low birth weight, but not postnatal weight gain, aggravates the course of nephrotic syndrome

  • Christian PlankEmail author
  • Iris Östreicher
  • Katalin Dittrich
  • Rüdiger Waldherr
  • Manfred Voigt
  • Kerstin Amann
  • Wolfgang Rascher
  • Jörg Dötsch
Original Article

Abstract

Clinical and animal studies have shown a higher risk of an aggravated course of renal disease in childhood after birth for babies small for gestational age (SGA). In addition relative “supernutrition” and fast weight gain in early infancy seem to support the development of later disease. In a retrospective analysis of 62 cases of idiopathic nephrotic syndrome treated between 1994 and 2004 at a university centre for paediatric nephrology, we related the course of disease to birth weight and to the weight gain in the first 2 years of life. Six children were born SGA (birth weight <−1.5 standard deviation score), and 56 were born as appropriate for gestational age (AGA). In all SGA children renal biopsy was performed, while only 55% of the AGA children underwent renal biopsy (P = 0.07), showing no difference in renal histology. In the SGA group, four of six patients developed steroid resistance (vs 12/56 AGA, P < 0.05). Of the SGA children, 83% needed antihypertensive treatment in the course of the disease compared to 39% of the AGA children (P = 0.07). The extent of weight gain between birth and 24 months of age did not influence the course of disease. In conclusion, we were able to find evidence for an aggravated course of idiopathic nephrotic syndrome in former SGA children. Independently of birth weight, weight gain in the first 2 years of life did not influence the course of disease.

Keywords

Nephrotic syndrome Child Low birth weight Small for gestational age Intrauterine growth restriction 

Notes

Acknowledgements

This study was supported by a grant from the Deutsche Forschungsgemeinschaft, Bonn, Germany; SFB 423, Collaborative Research Centre of the German Research Foundation Kidney Injury: Pathogenesis and Regenerative Mechanisms, project B13, to Wolfgang Rascher and Jörg Dötsch, and project Z2 to Kerstin Amann. We thank Elke Wühl for the data for SDS calculation of spontaneous blood pressure measurement in children. We gratefully appreciate the support of Melek Düz in conducting this study.

References

  1. 1.
    Eddy AA, Symons JM (2003) Nephrotic syndrome in childhood. Lancet 362:629–639PubMedGoogle Scholar
  2. 2.
    Abrantes MM, Cardoso LS, Lima EM, Penido Silva JM, Diniz JS, Bambirra EA, Oliveira EA (2006) Predictive factors of chronic kidney disease in primary focal segmental glomerulosclerosis. Pediatr Nephrol 21:1003–1012PubMedGoogle Scholar
  3. 3.
    Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ (1989) Weight in infancy and death from ischaemic heart disease. Lancet 2:577–580PubMedPubMedCentralGoogle Scholar
  4. 4.
    McMillen IC, Robinson JS (2005) Developmental origins of the metabolic syndrome: prediction, plasticity, and programming. Physiol Rev 85:571–633PubMedGoogle Scholar
  5. 5.
    Lackland DT, Bendall HE, Osmond C, Egan BM, Barker DJ (2000) Low birth weights contribute to high rates of early-onset chronic renal failure in the southeastern United States. Arch Intern Med 160:1472–1476PubMedGoogle Scholar
  6. 6.
    Lackland DT, Egan BM, Fan ZJ, Syddall HE (2001) Low birth weight contributes to the excess prevalence of end-stage renal disease in African Americans. J Clin Hypertens (Greenwich) 3:29–31Google Scholar
  7. 7.
    Hoy WE, Hughson MD, Bertram JF, Douglas-Denton R, Amann K (2005) Nephron number, hypertension, renal disease, and renal failure. J Am Soc Nephrol 16:2557–2564PubMedGoogle Scholar
  8. 8.
    Tanner JM (1986) Childhood epidemiology. Physical development. Br Med Bull 42:131–138PubMedGoogle Scholar
  9. 9.
    Karlberg J, Albertsson-Wikland K (1995) Growth in full-term small-for-gestational-age infants: from birth to final height. Pediatr Res 38:733–739PubMedGoogle Scholar
  10. 10.
    Hales CN, Ozanne SE (2003) For debate: Fetal and early postnatal growth restriction lead to diabetes, the metabolic syndrome and renal failure. Diabetologia 46:1013–1019PubMedGoogle Scholar
  11. 11.
    Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB (2000) Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. BMJ 320:967–971PubMedPubMedCentralGoogle Scholar
  12. 12.
    Hemachandra AH, Howards PP, Furth SL, Klebanoff MA (2007) Birth weight, postnatal growth, and risk for high blood pressure at 7 years of age: results from the Collaborative Perinatal Project. Pediatrics 119:e1264–e1270PubMedGoogle Scholar
  13. 13.
    Min JW, Kong KA, Park BH, Hong JH, Park EA, Cho SJ, Ha EH, Park H (2007) Effect of postnatal catch-up growth on blood pressure in children at 3 years of age. J Hum Hypertens DOI  10.1038/sj.jhh.1002215
  14. 14.
    Sheu JN, Chen JH (2001) Minimal change nephrotic syndrome in children with intrauterine growth retardation. Am J Kidney Dis 37:909–914PubMedGoogle Scholar
  15. 15.
    Na YW, Yang HJ, Choi JH, Yoo KH, Hong YS, Lee JW, Kim SK (2002) Effect of intrauterine growth retardation on the progression of nephrotic syndrome. Am J Nephrol 22:463–467PubMedGoogle Scholar
  16. 16.
    Zidar N, Cavic MA, Kenda RB, Koselj M, Ferluga D (1998) Effect of intrauterine growth retardation on the clinical course and prognosis of IgA glomerulonephritis in children. Nephron 79:28–32PubMedGoogle Scholar
  17. 17.
    Gardosi J (2006) New definition of small for gestational age based on fetal growth potential. Horm Res 65 [Suppl 3]:15–18PubMedGoogle Scholar
  18. 18.
    Voigt M, Friese K, Pawlowski P, Schneider R, Wenzlaff P, Wermke K (2001) Analysis of newborns in Germany between 1995 and 1997. Part 6: differences in birth weight classification among states. Geburtshilfe Frauenheilkd 61:700–706Google Scholar
  19. 19.
    Barker DJ, Osmond C, Forsen TJ, Kajantie E, Eriksson JG (2005) Trajectories of growth among children who have coronary events as adults. N Engl J Med 353:1802–1809PubMedGoogle Scholar
  20. 20.
    Cole TJ, Freeman JV, Preece MA (1998) British 1990 growth reference centiles for weight, height, body mass index and head circumference fitted by maximum penalized likelihood. Stat Med 17:407–429PubMedGoogle Scholar
  21. 21.
    Prader A, Largo RH, Molinari L, Issler C (1989) Physical growth of Swiss children from birth to 20 years of age. First Zurich longitudinal study of growth and development. Helv Paediatr Acta Suppl 52:1–125PubMedPubMedCentralGoogle Scholar
  22. 22.
    Schwartz GJ, Gauthier B (1985) A simple estimate of glomerular filtration rate in adolescent boys. J Pediatr 106:522–526PubMedPubMedCentralGoogle Scholar
  23. 23.
    de Man SA, Andre JL, Bachmann H, Grobbee DE, Ibsen KK, Laaser U, Lippert P, Hofman A (1991) Blood pressure in childhood: pooled findings of six European studies. J Hypertens 9:109–114PubMedGoogle Scholar
  24. 24.
    Ehrich JH, Brodehl J (1993) Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children. Arbeitsgemeinschaft fur Padiatrische Nephrologie. Eur J Pediatr 152:357–361PubMedGoogle Scholar
  25. 25.
    Hodson EM, Craig JC, Willis NS (2005) Evidence-based management of steroid-sensitive nephrotic syndrome. Pediatr Nephrol 20:1523–1530PubMedGoogle Scholar
  26. 26.
    Brodehl J (1981) Alternate-day prednisone is more effective than intermittent prednisone in frequently relapsing nephrotic syndrome. Eur J Pediatr 135:229–237Google Scholar
  27. 27.
    Zidar N, Avgustin Cavic M, Kenda RB, Ferluga D (1998) Unfavorable course of minimal change nephrotic syndrome in children with intrauterine growth retardation. Kidney Int 54:1320–1323PubMedGoogle Scholar
  28. 28.
    The International Study of Kidney Disease in Children (1981) The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. J Pediatr 98:561–564Google Scholar
  29. 29.
    Clark AG, Barratt TM (1999) Steroid responsive nephrotic syndrome. In: Barratt TM, Avner ED, Harmon WE (eds) Pediatric nephrology, 4th edn. Lippincott, Williams and Wilkins, Baltimore pp 731–747Google Scholar
  30. 30.
    Kim JS, Bellew CA, Silverstein DM, Aviles DH, Boineau FG, Vehaskari VM (2005) High incidence of initial and late steroid resistance in childhood nephrotic syndrome. Kidney Int 68:1275–1281PubMedGoogle Scholar
  31. 31.
    Dötsch J, Dittrich K, Plank C, Rascher W (2006) Is tacrolimus for childhood steroid-dependent nephrotic syndrome better than ciclosporin A? Nephrol Dial Transplant 21:1761–1763PubMedGoogle Scholar
  32. 32.
    El-Husseini A, El-Basuony F, Mahmoud I, Sheashaa H, Sabry A, Hassan R, Taha N, Hassan N, Sayed-Ahmad N, Sobh M (2005) Long-term effects of cyclosporine in children with idiopathic nephrotic syndrome: a single-centre experience. Nephrol Dial Transplant 20:2433–2438PubMedGoogle Scholar
  33. 33.
    Ponticelli C, Rizzoni G, Edefonti A, Altieri P, Rivolta E, Rinaldi S, Ghio L, Lusvarghi E, Gusmano R, Locatelli F, Pasquali S, Castellani A, Della Casa-Alberighi O (1993) A randomized trial of cyclosporine in steroid-resistant idiopathic nephrotic syndrome. Kidney Int 43:1377–1384PubMedGoogle Scholar
  34. 34.
    Huxley R, Neil A, Collins R (2002) Unravelling the fetal origins hypothesis: is there really an inverse association between birthweight and subsequent blood pressure? Lancet 360:659–665PubMedGoogle Scholar
  35. 35.
    Amann K, Plank C, Dötsch J (2004) Low nephron number—a new cardiovascular risk factor in children? Pediatr Nephrol 19:1319–1323PubMedGoogle Scholar
  36. 36.
    Hughson M, Farris AB 3rd, Douglas-Denton R, Hoy WE, Bertram JF (2003) Glomerular number and size in autopsy kidneys: the relationship to birth weight. Kidney Int 63:2113–2122PubMedGoogle Scholar
  37. 37.
    Keller G, Zimmer G, Mall G, Ritz E, Amann K (2003) Nephron number in patients with primary hypertension. N Engl J Med 348:101–108PubMedGoogle Scholar
  38. 38.
    Manning J, Vehaskari VM (2005) Postnatal modulation of prenatally programmed hypertension by dietary Na and ACE inhibition. Am J Physiol Regul Integr Comp Physiol 288:R80–R84PubMedGoogle Scholar
  39. 39.
    Woods LL, Weeks DA, Rasch R (2004) Programming of adult blood pressure by maternal protein restriction: role of nephrogenesis. Kidney Int 65:1339–1348PubMedGoogle Scholar
  40. 40.
    Hoppe CC, Evans RG, Moritz KM, Cullen-McEwen LA, Fitzgerald SM, Dowling J, Bertram JF (2007) Combined prenatal and postnatal protein restriction influences adult kidney structure, function, and arterial pressure. Am J Physiol Regul Integr Comp Physiol 292:R462–R469PubMedGoogle Scholar
  41. 41.
    Zimanyi MA, Denton KM, Forbes JM, Thallas-Bonke V, Thomas MC, Poon F, Black MJ (2006) A developmental nephron deficit in rats is associated with increased susceptibility to a secondary renal injury due to advanced glycation end-products. Diabetologia 49:801–810PubMedPubMedCentralGoogle Scholar
  42. 42.
    Plank C, Östreicher I, Hartner A, Marek I, Struwe FG, Amann K, Hilgers KF, Rascher W, Dötsch J (2006) Intrauterine growth retardation aggravates the course of acute mesangioproliferative glomerulonephritis in the rat. Kidney Int 70:1974–1982PubMedPubMedCentralGoogle Scholar
  43. 43.
    Niaudet P (2004) Genetic forms of nephrotic syndrome. Pediatr Nephrol 19:1313–1318PubMedGoogle Scholar
  44. 44.
    Savin VJ, Sharma R, Sharma M, McCarthy ET, Swan SK, Ellis E, Lovell H, Warady B, Gunwar S, Chonko AM, Artero M, Vincenti F (1996) Circulating factor associated with increased glomerular permeability to albumin in recurrent focal segmental glomerulosclerosis. N Engl J Med 334:878–883PubMedGoogle Scholar
  45. 45.
    Kemper MJ, Wolf G, Muller-Wiefel DE (2001) Transmission of glomerular permeability factor from a mother to her child. N Engl J Med 344:386–387PubMedGoogle Scholar
  46. 46.
    Carraro M, Caridi G, Bruschi M, Artero M, Bertelli R, Zennaro C, Musante L, Candiano G, Perfumo F, Ghiggeri GM (2002) Serum glomerular permeability activity in patients with podocin mutations (NPHS2) and steroid-resistant nephrotic syndrome. J Am Soc Nephrol 13:1946–1952PubMedGoogle Scholar
  47. 47.
    Koyama A, Fujisaki M, Kobayashi M, Igarashi M, Narita M (1991) A glomerular permeability factor produced by human T cell hybridomas. Kidney Int 40:453–460PubMedGoogle Scholar
  48. 48.
    Yan K, Nakahara K, Awa S, Nishibori Y, Nakajima N, Kataoka S, Maeda M, Watanabe T, Matsushima S, Watanabe N (1998) The increase of memory T cell subsets in children with idiopathic nephrotic syndrome. Nephron 79:274–278PubMedGoogle Scholar
  49. 49.
    Topaloglu R, Saatci U, Arikan M, Canpinar H, Bakkaloglu A, Kansu E (1994) T-cell subsets, interleukin-2 receptor expression and production of interleukin-2 in minimal change nephrotic syndrome. Pediatr Nephrol 8:649–652PubMedGoogle Scholar
  50. 50.
    Tomizawa S, Suzuki S, Oguri M, Kuroume T (1979) Studies of T lymphocyte function and inhibitory factors in minimal change nephrotic syndrome. Nephron 24:179–182PubMedGoogle Scholar
  51. 51.
    Cunard R, Kelly CJ (2002) T cells and minimal change disease. J Am Soc Nephrol 13:1409–1411Google Scholar
  52. 52.
    Chandra RK, Ali SK, Kutty KM, Chandra S (1977) Thymus-dependent lymphocytes and delayed hypersensitivity in low birth weight infants. Biol Neonate 31:15–18PubMedGoogle Scholar
  53. 53.
    Chatrath R, Saili A, Jain M, Dutta AK (1997) Immune status of full-term small-for-gestational age neonates in India. J Trop Pediatr 43:345–348PubMedGoogle Scholar

Copyright information

© IPNA 2007

Authors and Affiliations

  • Christian Plank
    • 1
    Email author
  • Iris Östreicher
    • 1
  • Katalin Dittrich
    • 1
  • Rüdiger Waldherr
    • 2
  • Manfred Voigt
    • 3
  • Kerstin Amann
    • 4
  • Wolfgang Rascher
    • 1
  • Jörg Dötsch
    • 1
  1. 1.Department of Paediatrics, Kinder- and JugendklinikUniversity of Erlangen-NurembergErlangenGermany
  2. 2.Institute for Clinical PathologyHeidelbergGermany
  3. 3.Department of PaediatricsErnst-Moritz-Arndt-University of GreifswaldGreifswaldGermany
  4. 4.Department of PathologyUniversity of Erlangen-NurembergErlangenGermany

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