The association of low birthweight and prematurity on outcomes in children and adults with nephrotic syndrome—a NEPTUNE cohort study

• Published in: Pediatric nephrology (Berlin, West) Vol. 38; no. 10; pp. 3297 - 3308
• Main Authors: Hingorani, Sangeeta, Gibson, Keisha L., Xie, Yuping, Wang, Yujie, Eddy, Sean, Hartman, John, Sampson, Matthew, Cassol, Clarissa, Thomas, David, Gipson, Debbie S., Trachtman, Howard, Srivastava, Tarak, Reidy, Kimberly
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2023; Springer; Springer Nature B.V
• Subjects: Adult; Apolipoprotein L1 - genetics; Birth Weight; Birth weight, Low; Care and treatment; Child; Children; Cohort analysis; Cohort Studies; Epidermal growth factor receptors; Female; Gene expression; Glomerular filtration rate; Glomerulosclerosis, Focal Segmental - pathology; Health aspects; Histopathology; Humans; Infant, Low Birth Weight; Infant, Newborn; Infants (Premature); Kidneys; Low birth weight; Medicine; Medicine & Public Health; Nephrology; Nephrotic syndrome; Nephrotic Syndrome - complications; Neptune; Original Article; Patient outcomes; Pediatrics; Premature birth; Premature Birth - epidemiology; Proteinuria; Proteinuria - complications; Proteinuria - etiology; Remission; Remission (Medicine); Urology; United States; FSGS; Minimal change disease; Nephrotic syndrome; Prematurity; Decline in kidney function
• ISSN: 0931-041X; 1432-198X; 1432-198X
• DOI: 10.1007/s00467-023-05876-3

Background In single-center studies, both preterm birth and low birth weight (LBW) are associated with worse outcomes in childhood nephrotic syndrome. Using the Nephrotic Syndrome Study Network (NEPTUNE) observational cohort, we tested the hypothesis that in patients with nephrotic syndrome, hypertension, proteinuria status, and disease progression would be more prevalent and more severe in subjects with LBW and prematurity singly or in combination (LBW/prematurity). Methods Three hundred fifty-nine adults and children with focal segmental glomerulosclerosis (FSGS) or minimal change disease (MCD) and available birth history were included. Estimated glomerular filtration rate (eGFR) decline and remission status were primary outcomes, and secondary outcomes were kidney histopathology, kidney gene expression, and urinary biomarkers. Logistic regression was used to identify associations with LBW/prematurity and these outcomes. Results We did not find an association between LBW/prematurity and remission of proteinuria. However, LBW/prematurity was associated with greater decline in eGFR. This decline in eGFR was partially explained by the association of LBW/prematurity with APOL1 high-risk alleles, but the association remained after adjustment. There were no differences in kidney histopathology or gene expression in the LBW/prematurity group compared to normal birth weight/term birth. Conclusion LBW and premature babies who develop nephrotic syndrome have a more rapid decline in kidney function. We did not identify clinical or laboratory features that distinguished the groups. Additional studies in larger groups are needed to fully ascertain the effects of (LBW) and prematurity alone or in combination on kidney function in the setting of nephrotic syndrome.