Obesity and preterm birth: additive risks in the progression of kidney disease in children
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ORIGINAL ARTICLE
Obesity and preterm birth: additive risks in the progression of kidney disease in children Carolyn L. Abitbol & Jayanthi Chandar & Maria M. Rodríguez & Mariana Berho & Wacharee Seeherunvong & Michael Freundlich & Gastón Zilleruelo
Received: 31 August 2008 / Revised: 23 November 2008 / Accepted: 15 December 2008 / Published online: 12 February 2009 # IPNA 2009
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. C. L. Abitbol (*) : J. Chandar : W. Seeherunvong : M. Freundlich : G. Zilleruelo Division of Pediatric Nephrology (M714), University of Miami/Holtz Children’s Hospital, 1611 NW 12th Avenue, Annex 5, Miami, FL 33126, USA e-mail: [email protected] M. M. Rodríguez : M. Berho Division of Pathology, University of Miami/Holtz Children’s Hospital, Miami, FL, USA
Obesity and preterm birth appear to impose additive risks for progression of kidney disease in childhood. Keywords Low birth weight . Obesity . Chronic kidney disease . Prematurity . Glomerulomegaly . Histomorphometry
Introduction Concomitant with the global obesity epidemic [1], there are a number of reports of obesity-related glomerulopathy (ORG) associated with progression of kidney diseases in adults and adolescents [2–5]. Some of these reports note a decrease in nephron mass by acquired unilateral nephrectomy or established renal disease [2, 4, 6–10]. ORG in adults has been defined as the clinical syndrome of morbid obesity, marked proteinuria without edema and normal serum albumin [3]. Histomorphometry describes glomerulomegaly which is thought to reflect glomerular hyperfiltration [8–10]. In the context of pediatric kidney disease, reduced nephron mass and increased risk for end-stage kidney disease (ESKD) has been associated with individuals born small for gestational age (SGA) as well as those born pr
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