Ultrasound Department, The Townsville Hospital, Douglas, Townsville, Australia.
College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia.
J Dev Orig Health Dis. 2021 Apr;12(2):184-192. doi: 10.1017/S204017442000015X. Epub 2020 Apr 15.
Chronic kidney disease continues to be under recognised and is associated with a significant global health burden and costs. An adverse intrauterine environment may result in a depleted nephron number and an increased risk of chronic kidney disease. Antenatal ultrasound was used to measure the foetal renal parenchymal thickness (RPT), as a novel method to estimate nephron number. Foetal renal artery blood flow was also assessed. This prospective, longitudinal study evaluated the foetal kidneys of 102 appropriately grown and 30 foetal growth-restricted foetuses between 20 and 37 weeks gestational age (GA) to provide vital knowledge on the influences foetal growth restriction has on the developing kidneys. The foetal RPT and renal artery blood flow were measured at least every 4 weeks using ultrasound. The RPT was found to be significantly thinner in growth-restricted foetuses compared to appropriately grown foetuses [likelihood ratio (LR) = 21.06, P ≤ 0.0001] and the difference increases with GA. In foetuses with the same head circumference, a growth-restricted foetus was more likely to have a thinner parenchyma than an appropriately grown foetus (LR = 8.9, P = 0.0028), supporting the principle that growth-restricted foetuses preferentially shunt blood towards the brain. No significant difference was seen in the renal arteries between appropriately grown and growth-restricted foetuses. Measurement of the RPT appears to be a more sensitive measure than current methods. It has the potential to identify infants with a possible reduced nephron endowment allowing for monitoring and interventions to be focused on individuals at a higher risk of developing future hypertension and chronic kidney disease.
慢性肾脏病仍然未被充分认识，它与巨大的全球健康负担和医疗费用有关。不良的宫内环境可能导致肾单位数量减少，慢性肾脏病的风险增加。产前超声用于测量胎儿肾实质厚度（RPT），作为估计肾单位数量的一种新方法。还评估了胎儿肾动脉血流。这项前瞻性、纵向研究评估了 102 名生长正常和 30 名胎儿生长受限胎儿的胎儿肾脏，这些胎儿的胎龄在 20 至 37 周之间，为胎儿生长受限对发育中肾脏的影响提供了重要知识。使用超声至少每 4 周测量一次胎儿 RPT 和肾动脉血流。与生长正常的胎儿相比，生长受限的胎儿的 RPT 明显更薄[似然比（LR）= 21.06，P ≤ 0.0001]，并且这种差异随着胎龄的增加而增加。在具有相同头围的胎儿中，生长受限的胎儿比生长正常的胎儿更有可能具有更薄的实质（LR = 8.9，P = 0.0028），支持了生长受限的胎儿优先将血液分流到大脑的原则。生长正常和生长受限的胎儿之间的肾动脉没有明显差异。RPT 的测量似乎比目前的方法更敏感。它有可能识别出可能存在肾单位减少的婴儿，从而能够进行监测，并将干预重点放在那些未来更有可能患高血压和慢性肾脏病的个体上。
