School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
NIHR Applied Research Collaboration Wessex, Southampton, UK.
BMC Nephrol. 2023 Feb 22;24(1):41. doi: 10.1186/s12882-023-03077-6.
Foetal and early childhood development contributes to the risk of adult non-communicable diseases such as hypertension and cardiovascular disease. We aimed to investigate whether kidney size at birth is associated with markers of kidney function at 7-11 years.
Foetal kidney dimensions were measured using ultrasound scans at 34 weeks gestation and used to derive kidney volume (cm) in 1802 participants in the Born in Bradford (BiB) birth cohort. Blood and urine samples were taken from those who participated in the BiB follow-up at 7-11 years (n = 630) and analysed for serum creatinine, cystatin C, urea, and urinary albumin to creatinine ratio (ACR), protein to creatinine ratio (PCR) and retinol binding protein (RBP). Estimated glomerular filtration rate (eGFR) was calculated using Schwartz creatinine only and combined with cystatin C, and cystatin C only Zappitelli and Filler equations. Linear regression was used to examine the association between foetal kidney volume and eGFR, ACR, PCR and blood pressure, unadjusted and adjusted for confounders.
Kidney volume was positively associated in adjusted models with eGFR calculated using Schwartz combined (0.64 ml/min diff per unit increase in volume, 95% CI 0.25 to 1.02), Zappitelli (0.79, 95% CI 0.38 to 1.20) and Filler (2.84, 95% CI 1.40 to 4.28). There was an association with the presence of albuminuria but not with its level, or with other urinary markers or with blood pressure.
Foetal kidney volume was associated with small increases in eGFR in mid-childhood. Longitudinal follow-up to investigate the relationship between kidney volume and markers of kidney function as children go through puberty is required.
胎儿和儿童早期发育会增加成年后患非传染性疾病（如高血压和心血管疾病）的风险。本研究旨在探讨胎儿期肾脏大小与 7-11 岁时肾功能标志物之间的关系。
在布拉德福德出生队列（BiB）研究中，对 34 孕周的胎儿进行超声扫描，测量胎儿肾脏尺寸，并用于计算 1802 名参与者的肾脏体积（cm）。在 BiB 随访中，对参加者（n=630）采集血样和尿样，用于分析血清肌酐、胱抑素 C、尿素、尿白蛋白/肌酐比值（ACR）、蛋白/肌酐比值（PCR）和视黄醇结合蛋白（RBP）。仅使用 Schwartz 肌酐估算肾小球滤过率（eGFR），并结合胱抑素 C 计算，以及使用 Zappitelli 和 Filler 方程仅使用胱抑素 C 计算。线性回归用于分析胎儿肾脏体积与 eGFR、ACR、PCR 和血压之间的关系，调整混杂因素后进行分析。
在调整模型中，肾脏体积与使用 Schwartz 联合方程计算的 eGFR 呈正相关（体积每增加一个单位，eGFR 增加 0.64ml/min，95%CI 0.25-1.02），与 Zappitelli 方程（0.79，95%CI 0.38-1.20）和 Filler 方程（2.84，95%CI 1.40-4.28）均呈正相关。肾脏体积与白蛋白尿的存在相关，但与白蛋白尿水平或其他尿液标志物或血压无关。
胎儿期肾脏体积与儿童中期 eGFR 的小幅度增加有关。需要进行纵向随访，以研究儿童进入青春期后肾脏体积与肾功能标志物之间的关系。
