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DOI: 10.1055/s-0031-1275294
© Georg Thieme Verlag KG Stuttgart · New York
Response: Preterm Birth – Another Risk Factor for Renal and Cardiovascular Diseases in Later Life ?
Frühgeburtlichkeit – ein weiterer Risikofaktor für renale und kardiovaskuläre Erkrankungen im späteren Leben?Publikationsverlauf
Publikationsdatum:
23. März 2011 (online)
![](https://www.thieme-connect.de/media/klinpaed/201102/lookinside/thumbnails/10.1055-s-0031-1275294-1.jpg)
Today perinatal events are established risk factors for diseases in later life. Overthe last 2 decades research in this field has predominantly focused on the outcome after small for gestational age (SGA) birth. The reason is that birth weight and gestational age can be easily accessed, even in retrospective studies.
Due to the fact that the number of surviving preterm babies is growing, scientific interest shifts toward the lifelong clinical outcome of this population. Beside the well known behavioral and cognitive consequences, several studies suggest blood pressure elevation in young adults after preterm birth [5] [6] [8] [9] [10] [13]. A recent Australian study examined the outcome after preterm birth in children at the age of 13–14 years [2]. Interestingly, there was no statistically significant difference in the blood pressure between former preterm SGA, preterm appropriate for gestational age (AGA), term SGA and term AGA children. However, the study showed an influence of SGA birth in preterm and term babies on the later systolic blood pressure. The authors concluded that intrauterine growth restriction (IUGR) is the more relevant risk factor for later systolic blood pressure than prematurity. Low nephron number and kidney mass is often accessed as an important reason for later renal disease and arterial hypertension in former SGA and IUGR children [4]. As a surrogate for reduced nephron number Keijzer-Veen et al. showed reduced kidney length and volume at least in former female preterm infants [7].
As a consequence of these data in former IUGR and SGA individuals [3], the suggestion by Dahlem [3] in his letter to the editor to look for an aggravation of secondary renal disease in former preterm infants seems reasonable. Nevertheless, there are some obstacles and confounders to be addressed in such projects. Neonatological morbidity and nephrotoxic treatment such as amino glycosides and diuretics must be considered as confounders in this setting [12]. As shown in the paper of our group on the course of Henoch-Schönlein Nephritis [11], weight gain and growth during infancy must be considered as isolated risk factors for the later course of kidney disease in preterms, too.
Nonetheless, elevated blood pressure, renal damage and the possibility of a higher risk for an aggravated course of renal disease should be kept in mind after IUGR and preterm delivery.
C. Plank, J. Dötsch
References
- 1 Bacchetta J, Harambat J, Dubourg L. et al . Both extrauterine and intrauterine growth restriction impair renal function in children born very preterm. Kidney Int. 2009; 76 445-452
- 2 Chan PY, Morris JM, Leslie GI. et al . The long-term effects of prematurity and intrauterine growth restriction on cardiovascular, renal, and metabolic function. Int J Pediatr. 2010; Epub 2010 Dec 14
- 3 Dahlem P. Perinatal Risk Factors and High Blood Pressure in Children with Renal Disease. Klin Padiatr. 2011; 223 95
- 4 Dötsch J, Plank C, Amann K. et al . The implications of fetal programming of glomerular number and renal function. J Mol Med. 2009; 87 841-848
- 5 Doyle LW, Faber B, Callanan C. et al . Blood pressure in late adolescence and very low birth weight. Pediatrics. 2003; 111 252-257
- 6 Johansson S, Iliadou A, Bergvall N. et al . S. Risk of high blood pressure among young men increases with the degree of immaturity at birth. Circulation. 2005 Nov 29; 112 (22) 3430-3436 Epub 2005 Nov 21
- 7 Keijzer-Veen MG, Devos AS, Meradji M. et al . Reduced renal length and volume 20 years after very preterm birth. Pediatr Nephrol. 2010; 25 499-507
- 8 Keijzer-Veen MG, Dülger A, Dekker FW. et al . Very preterm birth is a risk factor for increased systolic blood pressure at a young adult age. Pediatr Nephrol. 2010; 25 509-516
- 9 Kistner A, Celsi G, Vanpée M. et al . Increased systolic daily ambulatory blood pressure in adult women born preterm. Pediatr Nephrol. 2005; 20 232-233
- 10 Leon DA, Johansson M, Rasmussen F. Gestational age and growth rate of fetal mass are inversely associated with systolic blood pressure in young adults: an epidemiologic study of 165 136 Swedish men aged 18 years. Am J Epidemiol. 2000; 152 597-604
- 11 Plank C, Vasilache I, Dittrich K. et al . Early weight gain and outcome in Henoch-Schönlein nephritis. Klin Padiatr. 2010; 222 455-459
- 12 Suzuki M. Children's toxicology from bench to bed – Drug-induced renal injury (4): Effects of nephrotoxic compounds on fetal and developing kidney. J Toxicol Sci. 2009; 34 (S 02) SP267-SP271
- 13 Willemsen RH, de Kort SW, van der Kaay DC. et al . Independent effects of prematurity on metabolic and cardiovascular risk factors in short small-for-gestational-age children. J Clin Endocrinol Metab. 2008; 93 452-458
PD Dr. Christian Plank
Medical Practice for Pediatrics
Dr. Werner Dick & colleagues
Friedrichsplatz 19
90552 Röthenbach
Germany
Telefon: + 49/911/5706333
Fax: + 49/911/5700291
eMail: christianplank@gmx.net
Prof. Dr. Jörg Dötsch
Pediatrics
University of Cologne
Kerpener Straße 62
50937 Köln
Germany
Telefon: +49/221/478 4350
Fax: +49/221/478 4635
eMail: joerg.doetsch@uk-koeln.de