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Laag geboortegewicht: consequenties voor de nier?

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Tijdschrift voor kindergeneeskunde

Summary

In recent years, a relation has been shown between low birth weight and a higher risk of diseases in adult life, particularly hypertension, cardiovascular diseases and type 2 diabetes. Causal factor could be intrauterine growth retardation, which interferes with the development and function of organs (called programming).

Human and animal studies show that programming of the kidney leads to a reduced number of nephrons. In order to compensate, there is hyperfiltration in remnant nephrons, leading to glomerular and systemic hypertension and glomerulosclerosis, with renal failure as endpoint. Oligonephronia makes the kidneys more vulnerable: in case of accessory renal disease, prognosis seems to deteriorate with low birth weight.

The renin-angiotensin system (ras) appears to play an important role based on its influence on renal hemodynamics, which is altered when associated with low birth weight. Animal studies suggest the ras as means for pharmacological manipulation of the low birth weight consequences. However, more data is needed before coming to clinical implications.

Samenvatting

De laatste jaren is er bewijs geleverd voor een relatie tussen een laag geboortegewicht en een toegenomen risico op aandoeningen op latere leeftijd, zoals hypertensie, hart- en vaatziekten en diabetes mellitus type II. Oorzakelijk dient gedacht te worden aan intra-uteriene groeivertraging, hetgeen interfereert met de aanleg en functie van organen (herprogrammering genoemd).

Uit onderzoek bij de mens en diverse proefdiermodellen blijkt herprogrammering van de nier voor een afgenomen hoeveelheid nefronen te zorgen. Ter compensatie treedt er in de aanwezige nefronen hyperfiltratie op, leidend tot glomerulaire en systemische hypertensie en glomerulosclerose, met als eindpunt nierinsufficiëntie. Door het verminderde aantal nefronen zijn de nieren kwetsbaarder; in het geval van bijkomende renale aandoeningen lijkt de prognose slechter te zijn bij een laag geboortegewicht.

De rol van het renine-angiotensine-systeem (ras) is belangrijk gezien de invloed ervan op de renale hemodynamiek, die veranderd is bij een laag geboortegewicht. Uit proefdieronderzoek lijkt het ras een aangrijpingspunt te bieden voor medicamenteuze manipulatie van de gevolgen van een laag geboortegewicht. Aanvullende gegevens zijn echter noodzakelijk om tot klinische implicaties te komen.

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  1. www.bsl.nl/shop/tydschrift-vkindergeneeskunde-0376-7442.html

    M. F. Schreuder

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  1. M. F. Schreuder
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  2. M. Fodor
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  3. J. A. E. van Wijk
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  4. H. A. Delemarre-van de Waal
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Correspondence to M. F. Schreuder.

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M.F. Schreuder, agiko.

Correspondentieadres: M.F. Schreuder, vu medisch centrum, afdeling Kindergeneeskunde, Postbus 7057, 1007 MB Amsterdam.

Dr. M. Fodor, onderzoeker.

Dr. J.A.E. van Wijk, kinderarts-nefroloog.

Prof.dr. H.A. Delemarre-van de Waal, kinderarts-endocrinoloog. Onderzoeksinstituut Endocrinologie, Voortplanting en Metabolisme, afdeling Kindergeneeskunde, vu medisch centrum, Amsterdam.

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Schreuder, M.F., Fodor, M., van Wijk, J.A.E. et al. Laag geboortegewicht: consequenties voor de nier?. KIND 70, 49–53 (2002). https://doi.org/10.1007/BF03061371

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