Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada.
Pediatr Nephrol. 2019 Sep;34(9):1599-1605. doi: 10.1007/s00467-019-04255-1. Epub 2019 Apr 11.
Low birth weight (LBW)/prematurity have been proposed as risk factors for the development of kidney disease in adulthood. Whether there is an association between LBW/prematurity and poor renal outcomes in childhood onset nephrotic syndrome remains unknown.
Children with nephrotic syndrome diagnosed between 1 and 18 years of age were followed prospectively from 1996 to 2016 at The Hospital for Sick Children (N = 377). LBW/prematurity was defined as birth weight < 2500 g or gestational age < 36 weeks. Normal birth weight (NBW) was defined as birth weight ≥ 2500 g. Measures evaluating clinical course of nephrotic syndrome include initial steroid-resistant nephrotic syndrome (SRNS), time to first relapse, and frequently relapsing nephrotic syndrome. Kaplan-Meier survival analysis, logistic regression, and Cox proportional hazards regression were used to determine the association of LBW/prematurity with clinical outcomes.
Median birth weights in LBW/premature (n = 46) and NBW (n = 331) children were 2098 g (interquartile range [IQR] 1700-2325 g) and 3317 g (IQR 2977-3685 g), respectively. Odds of having SRNS were 3.78 (95% confidence interval [CI] 1.28-11.21) times higher among LBW/premature children than NBW children. An 8% decrease in odds of developing SRNS was observed for every 100 g increase in birth weight (adjusted odds ratio [OR] 0.92; 95% CI 0.86-0.98). Median time to first relapse did not differ (hazard ratio [HR] 0.89; 95% CI 0.53-1.16).
LBW/premature children were more likely to develop SRNS but did not have a difference in time to first relapse with NBW children. Understanding the impact and mechanism of birth weight and steroid-resistant disease needs further study.
低出生体重（LBW）/早产被认为是成年后患肾脏疾病的危险因素。LBW/早产与儿童期起病肾病综合征的不良肾脏结局之间是否存在关联尚不清楚。
1996 年至 2016 年，在多伦多 SickKids 医院前瞻性随访诊断为 1 至 18 岁肾病综合征的患儿（n=377）。LBW/早产定义为出生体重<2500g 或胎龄<36 周。正常出生体重（NBW）定义为出生体重≥2500g。评估肾病综合征临床病程的指标包括初始激素抵抗性肾病综合征（SRNS）、首次复发时间和频繁复发肾病综合征。采用 Kaplan-Meier 生存分析、Logistic 回归和 Cox 比例风险回归来确定 LBW/早产与临床结局的关系。
LBW/早产（n=46）和 NBW（n=331）儿童的中位出生体重分别为 2098g（四分位间距 [IQR] 1700-2325g）和 3317g（IQR 2977-3685g）。LBW/早产儿童发生 SRNS 的几率是 NBW 儿童的 3.78 倍（95%置信区间 [CI] 1.28-11.21）。出生体重每增加 100g，发生 SRNS 的几率降低 8%（调整后的优势比 [OR] 0.92；95%CI 0.86-0.98）。首次复发时间中位数无差异（风险比 [HR] 0.89；95%CI 0.53-1.16）。
LBW/早产儿童更易发生 SRNS，但与 NBW 儿童相比，首次复发时间无差异。进一步研究需要了解出生体重和激素抵抗性疾病的影响和机制。
