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Fetal growth restriction followed by very preterm birth is associated with smaller kidneys but preserved kidney function in adolescence

Liefke, Jonas LU ; Heijl, Caroline LU ; Steding Ehrenborg, Katarina LU ; Morsing, Eva LU ; Arheden, Håkan LU and Ley, David LU (2023) In Pediatric Nephrology 38(6). p.1855-1866
Abstract
Background: Preterm birth and fetal growth restriction (FGR) are associated with structural and functional kidney changes, increasing long-term risk for chronic kidney disease and hypertension. However, recent studies in preterm children are conflicting, indicating structural changes but normal kidney function. This study therefore assessed kidney structure and function in a cohort of adolescents born very preterm with and without verified FGR.
Methods: Adolescents born very preterm with FGR and two groups with appropriate birthweight (AGA) were included; one matched for gestational week at birth and one born at term. Cortical and medullary kidney volumes and T1 and T2* mapping values were assessed by magnetic resonance imaging.... (More)
Background: Preterm birth and fetal growth restriction (FGR) are associated with structural and functional kidney changes, increasing long-term risk for chronic kidney disease and hypertension. However, recent studies in preterm children are conflicting, indicating structural changes but normal kidney function. This study therefore assessed kidney structure and function in a cohort of adolescents born very preterm with and without verified FGR.
Methods: Adolescents born very preterm with FGR and two groups with appropriate birthweight (AGA) were included; one matched for gestational week at birth and one born at term. Cortical and medullary kidney volumes and T1 and T2* mapping values were assessed by magnetic resonance imaging. Biochemical markers of kidney function and renin-angiotensin-aldosterone system (RAAS) activation were analyzed.
Results: Sixty-four adolescents were included (13-16 years; 48% girls). Very preterm birth with FGR showed smaller total (66 vs. 75 ml/m2; p = 0.01) and medullary volume (19 vs. 24 ml/m2; p < 0.0001) compared to term AGA. Corticomedullary volume ratio decreased from preterm FGR (2.4) to preterm AGA (2.2) to term AGA (1.9; p = 0.004). There were no differences in T1 or T2* values (all p ≥ 0.34) or in biochemical markers (all p ≥ 0.12) between groups.
Conclusions: FGR with abnormal fetal blood flow followed by very preterm birth is associated with smaller total kidney and medullary kidney volumes, but not with markers of kidney dysfunction or RAAS activation in adolescence. Decreased total kidney and medullary volumes may still precede a long-term decrease in kidney function, and potentially be used as a prognostic marker. A higher resolution version of the Graphical abstract is available as Supplementary information. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Pediatric Nephrology
volume
38
issue
6
pages
1855 - 1866
publisher
Springer
external identifiers
  • pmid:36409369
  • scopus:85142348277
ISSN
1432-198X
DOI
10.1007/s00467-022-05785-x
language
English
LU publication?
yes
id
f7f861b1-d148-42e4-9b24-f96a2961b187
date added to LUP
2022-11-25 09:12:47
date last changed
2023-10-26 14:56:20
@article{f7f861b1-d148-42e4-9b24-f96a2961b187,
  abstract     = {{Background: Preterm birth and fetal growth restriction (FGR) are associated with structural and functional kidney changes, increasing long-term risk for chronic kidney disease and hypertension. However, recent studies in preterm children are conflicting, indicating structural changes but normal kidney function. This study therefore assessed kidney structure and function in a cohort of adolescents born very preterm with and without verified FGR.<br/>Methods: Adolescents born very preterm with FGR and two groups with appropriate birthweight (AGA) were included; one matched for gestational week at birth and one born at term. Cortical and medullary kidney volumes and T1 and T2* mapping values were assessed by magnetic resonance imaging. Biochemical markers of kidney function and renin-angiotensin-aldosterone system (RAAS) activation were analyzed.<br/>Results: Sixty-four adolescents were included (13-16 years; 48% girls). Very preterm birth with FGR showed smaller total (66 vs. 75 ml/m2; p = 0.01) and medullary volume (19 vs. 24 ml/m2; p &lt; 0.0001) compared to term AGA. Corticomedullary volume ratio decreased from preterm FGR (2.4) to preterm AGA (2.2) to term AGA (1.9; p = 0.004). There were no differences in T1 or T2* values (all p ≥ 0.34) or in biochemical markers (all p ≥ 0.12) between groups.<br/>Conclusions: FGR with abnormal fetal blood flow followed by very preterm birth is associated with smaller total kidney and medullary kidney volumes, but not with markers of kidney dysfunction or RAAS activation in adolescence. Decreased total kidney and medullary volumes may still precede a long-term decrease in kidney function, and potentially be used as a prognostic marker. A higher resolution version of the Graphical abstract is available as Supplementary information.}},
  author       = {{Liefke, Jonas and Heijl, Caroline and Steding Ehrenborg, Katarina and Morsing, Eva and Arheden, Håkan and Ley, David}},
  issn         = {{1432-198X}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1855--1866}},
  publisher    = {{Springer}},
  series       = {{Pediatric Nephrology}},
  title        = {{Fetal growth restriction followed by very preterm birth is associated with smaller kidneys but preserved kidney function in adolescence}},
  url          = {{http://dx.doi.org/10.1007/s00467-022-05785-x}},
  doi          = {{10.1007/s00467-022-05785-x}},
  volume       = {{38}},
  year         = {{2023}},
}