Onodera Chinatsu, Ishikawa Ken, Sugawara Hiroshi, Nishimi Saeko, Furukawa Hiromi, Takada Akira, Akasaka Manami, Kobayashi Megumi
Department of Pediatrics, School of Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate Prefecture, 028-3694, Japan.
Department of Pediatric Surgery, School of Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate Prefecture, 028-3694, Japan.
CEN Case Rep. 2025 Apr;14(2):224-229. doi: 10.1007/s13730-024-00931-w. Epub 2024 Oct 5.
Chronic kidney disease associated with low birth weight and/or premature birth (L/P-CKD) in infants may result from a decreased number of nephrons at birth. These infants may develop acute kidney injury due to exposure to nephrotoxic substances or other events during nephrogenesis in early infancy. Nonetheless, L/P-CKD progression remains unclear. We present three cases of L/P-CKD diagnosed after neonatal intensive care unit (NICU) discharge. Three patients were born extremely prematurely (gestational age, 24-26 weeks) with extremely low birth weight (606-906 g). They were admitted to the NICU (117-311 days) anad received several nephrotoxic medications during the early postnatal period. They showed elevated serum creatinine levels at 4 weeks after birth, which decreased to normal levels at NICU discharge. Proteinuria was first detected during adolescence (10-15 years) on annual school urine screening, with a remarkable increase in their height (18 - 50.8 cm), without known episodes of urinary tract infection, dehydration, lifestyle-related issues, such as excessive salt/protein intake, and extreme lack of exercise that might have caused kidney damage. Their kidneys were smaller than normal on renal ultrasonography. Open renal biopsy findings indicated glomerulomegaly and perihilar glomerulosclerosis in two of the three patients, suggesting glomerular hypertension. The remarkable differences between the body height before CKD and the timing of diagnosis of CKD could contribute to the progress of CKD. Long-term follow-up of low birth weight and extremely premature infants, from NICU discharge until adulthood, should be established.
婴儿慢性肾脏病与低出生体重和/或早产（L/P-CKD）可能源于出生时肾单位数量减少。这些婴儿在婴儿早期肾发生过程中因接触肾毒性物质或其他事件可能发生急性肾损伤。尽管如此，L/P-CKD的进展仍不明确。我们报告3例在新生儿重症监护病房（NICU）出院后诊断为L/P-CKD的病例。3例患者均为极早早产儿（胎龄24 - 26周），出生体重极低（606 - 906克）。他们入住NICU（117 - 311天），并在出生后早期接受了几种肾毒性药物治疗。他们在出生后4周时血清肌酐水平升高，在NICU出院时降至正常水平。蛋白尿在青春期（10 - 15岁）每年学校尿液筛查时首次发现，身高有显著增长（18 - 50.8厘米），无已知的尿路感染、脱水、生活方式相关问题，如过量盐/蛋白质摄入以及可能导致肾损伤的极度缺乏运动的情况。肾脏超声检查显示他们的肾脏比正常小。开放性肾活检结果显示，3例患者中有2例存在肾小球肿大和肾门周围肾小球硬化，提示肾小球高压。CKD发生前的身高与CKD诊断时间的显著差异可能促使CKD进展。应建立对低出生体重和极早早产儿从NICU出院直至成年的长期随访。
