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Polycythemia, capillary rarefaction, and focal glomerulosclerosis in two adolescents born extremely low birth weight and premature

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Abstract

Background

Low birthweight infants have a reduced number of nephrons and are at high risk of chronic kidney disease. Preterm birth and/or intrauterine growth restriction (IUGR) may also affect peritubular capillary development, as has been shown in other organs.

Case-Diagnosis/Treatment

We report two patients with a history of preterm birth and extremely low birthweight who showed polycythemia and renal capillary rarefaction. Patient 1 and 2, born at 25 weeks of gestation with a birthweight of 728 and 466 g, showed mild proteinuria at age 8 and 6 years, respectively. In addition to increasing proteinuria, hemoglobin levels became elevated towards adolescence and their serum erythropoietin (EPO) was high despite polycythemia. Light microscopic examination of renal biopsy specimens showed glomerular hypertrophy, focal segmental glomerulosclerosis, and only mild tubulointerstitial fibrosis. A decrease in the immunohistochemical staining of CD31 and CD34 endothelial cells in renal biopsy specimens was consistent with peritubular capillary rarefaction.

Conclusions

Since kidney function was almost normal and fibrosis was not severe, we consider that the capillary rarefaction and polycythemia associated with elevated EPO levels were largely attributable to preterm birth and/or IUGR.

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Acknowledgments

This study was supported by JSPS KAKENHI Grant Number 15K09726, 26461620, and 15H06591, The Japan Foundation for Pediatric Research (Grant No14-008) and Takeda Science Foundation.

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Authors and Affiliations

  1. Department of Pediatrics, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Nariaki Asada & Midori Awazu

  2. Department of Pediatrics, Shinshu University, Nagano, Japan

    Takanori Tsukahara, Daisuke Matsuoka & Shunsuke Noda

  3. Department of Pediatrics, Saku Central Hospital, Nagano, Japan

    Megumi Furuhata

  4. Department of Pediatrics, Iida Municipal Hospital, Nagano, Japan

    Kuniaki Naganuma

  5. Department of Pathology, Keio University School of Medicine, Tokyo, Japan

    Akinori Hashiguchi

Authors
  1. Nariaki Asada
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  2. Takanori Tsukahara
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  3. Megumi Furuhata
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  4. Daisuke Matsuoka
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  5. Shunsuke Noda
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  6. Kuniaki Naganuma
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  7. Akinori Hashiguchi
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  8. Midori Awazu
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Corresponding author

Correspondence to Nariaki Asada.

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The authors have no conflicts of interest relevant to this article to disclose.

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Asada, N., Tsukahara, T., Furuhata, M. et al. Polycythemia, capillary rarefaction, and focal glomerulosclerosis in two adolescents born extremely low birth weight and premature. Pediatr Nephrol 32, 1275–1278 (2017). https://doi.org/10.1007/s00467-017-3654-z

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  • DOI: https://doi.org/10.1007/s00467-017-3654-z

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