Koike Kentaro, Ikezumi Yohei, Tsuboi Nobuo, Kanzaki Go, Haruhara Kotaro, Okabayashi Yusuke, Sasaki Takaya, Ogura Makoto, Saitoh Akihiko, Yokoo Takashi
Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan; and.
Department of Pediatrics, Niigata University Medical and Dental Hospital, Niigata, Japan.
Clin J Am Soc Nephrol. 2017 Apr 3;12(4):585-590. doi: 10.2215/CJN.05650516. Epub 2017 Mar 23.
A low total nephron number, which is associated with low birth weight (LBW), may indicate increased susceptibility to early-onset renal diseases in children. However, few studies have assessed renal biopsy findings in LBW children. We examined the relationship between LBW and glomerular density (GD) and/or glomerular volume (GV) in renal biopsy samples as a surrogate for total nephron number.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Renal biopsy findings of children of LBW were compared with those of age-matched control subjects of normal birth weight (NBW) who were histopathologically diagnosed with FSGS or minimal change nephrotic syndrome (MCNS) from 1995 to 2011. The GD and GV were estimated on the basis of measurements obtained by computerized image analysis.
A total of 31 subjects (mean age 11 years; eight with low birth weight-FSGS [LBW-FSGS], 10 with normal birth weight-FSGS [NBW-FSGS], and 13 with normal birth weight-minimal change nephrotic syndrome [NBW-MCNS]) were analyzed. The mean birth weight of each group was 777 g (629-1000), 3110 g (2888-3358), and 3120 g (2748-3398), respectively (median [25th-75th percentile]). Age, body mass index, BP, and degrees of globally sclerotic glomeruli at biopsy were comparable between the groups. The GD was lower (LBW-FSGS, 1.4±0.6/mm; NBW-FSGS, 3.3±1.2/mm; and NBW-MCNS, 3.6±1.1/mm; <0.05) and the GV was greater (LBW-FSGS, 4.1 [3.1-5.1]×10m; NBW-FSGS, 1.6 [1.5-2.1]×10m; and NBW-MCNS, 1.3 [1.1-1.8]×10m [median, (25th-75th percentile)]; <0.05) in patients with LBW-FSGS than in the other patient groups. The GD showed close positive correlations with birth weight (=0.48) and gestational age (=0.54), independent of renal function and degree of global glomerular sclerosis.
A low GD together with marked glomerular enlargement characterizes renal biopsy samples of children born with a LBW at an early stage of gestation.
低总肾单位数量与低出生体重（LBW）相关，可能表明儿童易患早发性肾脏疾病。然而，很少有研究评估低出生体重儿童的肾活检结果。我们研究了肾活检样本中低出生体重与肾小球密度（GD）和/或肾小球体积（GV）之间的关系，以此作为总肾单位数量的替代指标。
设计、地点、参与者及测量方法：将1995年至2011年期间组织病理学诊断为局灶节段性肾小球硬化（FSGS）或微小病变肾病综合征（MCNS）的低出生体重儿童的肾活检结果与年龄匹配的正常出生体重（NBW）对照受试者的结果进行比较。基于计算机图像分析获得的测量值估算GD和GV。
共分析了31名受试者（平均年龄11岁；8例低出生体重 - FSGS [LBW - FSGS]，10例正常出生体重 - FSGS [NBW - FSGS]，13例正常出生体重 - 微小病变肾病综合征 [NBW - MCNS]）。每组的平均出生体重分别为777 g（629 - 1000）、3110 g（2888 - 3358）和3120 g（2748 - 3398）（中位数[第25 - 75百分位数]）。各组间年龄、体重指数、血压和活检时全球硬化肾小球的程度相当。LBW - FSGS患者的GD较低（LBW - FSGS，1.4±0.6/mm；NBW - FSGS，3.3±1.2/mm；NBW - MCNS，3.6±1.1/mm；<0.05），GV较大（LBW - FSGS，4.1 [3.1 - 5.1]×10m；NBW - FSGS，1.6 [1.5 - 2.1]×10m；NBW - MCNS，1.3 [1.1 - 1.8]×10m [中位数，(第25 - 75百分位数)]；<0.05），与其他患者组相比。GD与出生体重（=0.48）和胎龄（=0.54）呈密切正相关，与肾功能和全球肾小球硬化程度无关。
低GD以及明显的肾小球增大是妊娠早期低出生体重儿童肾活检样本的特征。
