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Obesity and preterm birth: additive risks in the progression of kidney disease in children

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Abstract

Preterm birth is associated with decreased nephron mass and obesity that may impact on kidney disease progression in later life. Our objectives were to examine the relative risks of obesity and preterm birth on the progression of kidney disease in children. In a retrospective cohort study, 80 (44 obese and 36 non-obese) patients with proteinuric kidney disease were studied for disease progression and glomerular histomorphometry. Of the obese, 22 had been born at term (Obese-T) and 22 had been preterm (Obese-PT). Seventeen non-obese children with focal glomerular sclerosis, born at term (NO-FSGS), and 19 non-obese preterm (NO-PT) children, served as controls. Insulin resistance as measured by the homeostatic model assessment (HOMA-IR) was elevated in all obese children. Obese-PT patients had increased risk of renal demise during childhood when compared with Obese-T children [hazard ratio 2.4; 95% Confidence interval (95% CI) 1.1 to 7.1; P = 0.04]. In obese children, although proteinuria often exceeded nephrotic range, average levels of serum albumin remained normal. Preterm patients were more likely to have reduced renal mass (odds ratio 4.7; P = 0.006), but obesity was not a factor. Renal histomorphometry showed glomerulomegaly in obese patients, regardless of birth weight. Obesity and preterm birth appear to impose additive risks for progression of kidney disease in childhood.

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Acknowledgments

This study was supported in part by a grant from Florida’s Department of Health, Children’s Medical Services.

The authors have no conflict of interests referable to the content of the manuscript or financial interest in any of the products or procedures mentioned.

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Authors and Affiliations

  1. Division of Pediatric Nephrology (M714), University of Miami/Holtz Children’s Hospital, 1611 NW 12th Avenue, Annex 5, Miami, FL, 33126, USA

    Carolyn L. Abitbol, Jayanthi Chandar, Wacharee Seeherunvong, Michael Freundlich & Gastón Zilleruelo

  2. Division of Pathology, University of Miami/Holtz Children’s Hospital, Miami, FL, USA

    Maria M. Rodríguez & Mariana Berho

Authors
  1. Carolyn L. Abitbol
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  2. Jayanthi Chandar
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  3. Maria M. Rodríguez
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  5. Wacharee Seeherunvong
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  6. Michael Freundlich
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  7. Gastón Zilleruelo
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Correspondence to Carolyn L. Abitbol.

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Abitbol, C.L., Chandar, J., Rodríguez, M.M. et al. Obesity and preterm birth: additive risks in the progression of kidney disease in children. Pediatr Nephrol 24, 1363–1370 (2009). https://doi.org/10.1007/s00467-009-1120-2

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  • DOI: https://doi.org/10.1007/s00467-009-1120-2

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