Low Birth Weight is Associated with More Severe Course of Steroid-Sensitive Nephrotic Syndrome in Children, Multicentric Study

Abstract

Background Several previous studies have reported a more severe course of nephrotic syndrome in children with low birth weight.

Patients Cohort of 223 children with idiopathic nephrotic syndrome.

Methods We aimed to investigate the association between course of nephrotic syndrome and low birth weight. Data from seven paediatric nephrology centres were used.

Results Children with low birth weight had 3.84 times higher odds for a more severe course of steroid-sensitive nephrotic syndrome (95% CI 1.20–17.22, P=0.041), and those with low birth weight and remission after 7 days had much higher odds for a more severe course of disease (OR 8.7). Low birth weight children had a longer time to remission (median 12 vs. 10 days, P=0.03). They had a higher need for steroid-sparing agents (OR for the same sex=3.26 [95% CI 1.17–11.62, P=0.039]), and the odds were even higher in females with low birth weight (OR 6.81). There was no evidence of an association either between low birth weight and focal segmental glomerulosclerosis or between low birth weight and steroid-resistant nephrotic syndrome.

Discussion We conducted the first multicentric study confirming the worse outcomes of children with NS and LBW and we found additional risk factors.

Conclusions Low birth weight is associated with a more severe course of steroid-sensitive nephrotic syndrome, while being female and achieving remission after 7 days are additional risk factors.

Zusammenfassung

Hintergrund Mehrere frühere Studien haben über einen schwereren Verlauf des nephrotischen Syndroms bei Kindern mit niedrigem Geburtsgewicht berichtet.

Patienten Kohorte von 223 Kindern mit idiopathischem nephrotischen Syndrom.

Methoden Das Ziel war den Zusammenhang zwischen dem Verlauf des nephrotischen Syndroms und niedrigem Geburtsgewicht zu untersuchen. Es wurden Daten aus sieben pädiatrischen Nephrologiezentren verwendet.

Ergebnisse Kinder mit niedrigem Geburtsgewicht hatten eine 3,84-mal höhere Wahrscheinlichkeit eines schwereren Verlaufs des steroidsensitiven nephrotischen Syndroms (95% KI 1,20–17,22, P=0,041), und Kinder mit niedrigem Geburtsgewicht und Remission nach 7 Tagen hatten eine viel höhere Chance für einen schwereren Krankheitsverlauf (OR 8,7). Kinder mit niedrigem Geburtsgewicht hatten eine längere Zeit bis zur Remission (Median 12 vs. 10 Tage, P=0,03). Sie hatten einen höheren Bedarf an steroidsparenden Mitteln (OR für das gleiche Geschlecht=3,26 [95% KI 1,17–11,62, P=0,039]), und die Wahrscheinlichkeit war bei Frauen mit niedrigem Geburtsgewicht sogar noch höher (OR 6,81). Es gab weder Hinweise auf einen Zusammenhang zwischen niedrigem Geburtsgewicht und fokaler segmentaler Glomerulosklerose noch zwischen niedrigem Geburtsgewicht und steroidresistentem nephrotischen Syndrom.

Diskussion Wir haben die erste multizentrische Studie durchgeführt, die die schlechteren Ergebnisse von Kindern mit NS und niedrigem Geburtsgewicht bestätigt, und wir haben zusätzliche Risikofaktoren gefunden.

Schlussfolgerungen Ein niedriges Geburtsgewicht ist mit einem schwereren Verlauf des steroidsensitiven nephrotischen Syndroms assoziiert, während das weibliche Geschlecht und das Erreichen einer Remission nach 7 Tagen zusätzliche Risikofaktoren sind.

Key words

Remission - Low birth weight - nephrotic syndrome - children - steroidsparing agent

Schlüsselwörter

Remission - niedriges Geburtsgewicht - nephrotisches Syndrom - Kinder - steroidsparende Mittel

Publication History

Article published online:
06 February 2024

• References

• 1 Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 Clinical Practice Guideline for the Management of Glomerular Diseases. Kidney Int 2021; 100: S1-S276
• 2 Noone DG, Iijima K, Parekh R. Idiopathic nephrotic syndrome in children. Lancet 2018; 392: 61-74
• 3 Tune BM, Mendoza SA. Treatment of the idiopathic nephrotic syndrome: regimens and outcomes in children and adults. J Am Soc Nephrol 1997; 8: 824-832
• 4 Low Birth Weight and Nephron Number Working Group. The impact of kidney development on the life course: a consensus document for action. Nephron 2017; 136: 3-49
• 5 Brenner BM, Garcia DL, Anderson S. Glomeruli and blood pressure. Less of one, more the other?. Am J Hypertens 1988; 1: 335-347
• 6 Faa G, Gerosa C, Fanni D. et al. Morphogenesis and molecular mechanisms involved in human kidney development. J Cell Physiol 2012; 227: 1257-1268
• 7 Hoy WE, Hughson MD, Bertram JF. et al. Nephron number, hypertension, renal disease, and renal failure. J Am Soc Nephrol 2015; 16: 2557-2564
• 8 Rodríguez MM, Gómez AH, Abitbol CL. et al. Histomorphometric analysis of postnatal glomerulogenesis in extremely preterm infants. Pediatr Dev Pathol 2004; 7: 17-25
• 9 Mañalich R, Reyes L, Herrera M. et al. Relationship between weight at birth and the number and size of renal glomeruli in humans: a histomorphometric study. Kidney Int 2000; 58: 770-773
• 10 World Health Organization. Global Nutrition Targets 2025: Low birth weight policy brief (WHO/NMH/NHD/14.5) (2014). Online: http://apps.who.int/iris/bitstream/handle/10665/149020/WHO_NMH_NHD_14.5_eng.pdf?ua=1 last accessed: 01.08.2023
• 11 Zidar N, Avgustin Cavić M, Kenda RB. et al. Unfavorable course of minimal change nephrotic syndrome in children with intrauterine growth retardation. Kidney Int 1998; 54: 1320-1323
• 12 Sheu JN, Chen JH. Minimal change nephrotic syndrome in children with intrauterine growth retardation. Am J Kidney Dis 2001; 37: 909-914
• 13 Na YW, Yang HJ, Choi JH. et al. Effect of intrauterine growth retardation on the progression of nephrotic syndrome. Am J Nephrol 2002; 22: 463-467
• 14 Plank C, Ostreicher I, Dittrich K. et al. Low birth weight, but not postnatal weight gain, aggravates the course of nephrotic syndrome. Pediatr Nephrol 2007; 22: 1881-1889
• 15 Teeninga N, Schreuder MF, Bökenkamp A. et al. Influence of low birth weight on minimal change nephrotic syndrome in children, including a meta-analysis. Nephrol Dial Transplant 2008; 23: 1615-1620
• 16 Conti G, De Vivo D, Fede C. et al. Low birth weight is a conditioning factor for podocyte alteration and steroid dependence in children with nephrotic syndrome. J Nephrol 2018; 31: 411-415
• 17 Konstantelos N, Banh T, Patel V. et al. Association of low birth weight and prematurity with clinical outcomes of childhood nephrotic syndrome: a prospective cohort study. Pediatr Nephrol 2019; 34: 1599-1605
• 18 Chen CC. et al. “Premature birth carries a higher risk of nephrotic syndrome: a cohort study.”. Scientific reports 11: 20639
• 19 Taneja V. Sex Hormones Determine Immune Response. Front Immunol 2018; 9: 1931
• 20 Letavernier B, Letavernier E, Leroy S. et al. Prediction of high-degree steroid dependency in pediatric idiopathic nephrotic syndrome. Pediatr Nephrol 2008; 23: 2221-2226
• 21 Constantinescu AR, Shah HB, Foote EF. et al. Predicting first-year relapses in children with nephrotic syndrome. Pediatrics 2000; 105: 492-495
• 22 Hodgin JB, Rasoulpour M, Markowitz GS. et al. Very low birth weight is a risk factor for secondary focal segmental glomerulosclerosis. Clin J Am Soc Nephrol 2009; 4: 71-76
• 23 Ikezumi Y, Suzuki T, Karasawa T. et al. Low birthweight and premature birth are risk factors for podocytopenia and focal segmental glomerulosclerosis. Am J Nephrol 2013; 38: 149-157
• 24 Barg E, Gasiorowski K, Brokos B. et al. A high frequency of apoptosis was found in cultures of lymphocytes isolated from the venous blood of children born with a low birth weight. Cell Mol Biol Lett 2004; 9: 135-143
• 25 Chandra RK, Ali SK, Kutty KM. et al. Thymus-dependent lymphocytes and delayed hypersensitivity in low birth weight infants. Biol Neonate 1997; 31: 15-18
• 26 Bussel JB, Cunningham-Rundles S, LaGamma EF. et al. Analysis of lymphocyte proliferative response subpopulations in very low birth weight infants and during the first 8 weeks of life. Pediatr Res 1988; 23: 457-462
• 27 Raqib R, Alam DS, Sarker P. et al. Low birth weight is associated with altered immune function in rural Bangladeshi children: a birth cohort study. Am J Clin Nutr 2007; 85: 845-852
• 28 Seidman DS, Slater PE, Ever-Hadani P. et al. Accuracy of mothers’ recall of birthweight and gestational age. Br J Obstet Gynaecol 1987; 94: 731-735
• 29 O’Sullivan JJ, Pearce MS, Parker L. Parental recall of birth weight: how accurate is it?. Arch Dis Child 2000; 82: 202-203