THE EFFECT OF INTRAUTERINE GROWTH-RETARDATION ON THE DEVELOPMENT OF RENAL NEPHRONS
THE EFFECT OF INTRAUTERINE GROWTH-RETARDATION ON THE DEVELOPMENT OF RENAL NEPHRONS
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DOI：
10.1111/j.1471-0528.1992.tb13726.x
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发表时间：
1992-04-01
期刊：
影响因子：
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通讯作者：
VANVELZEN, D
中科院分区：
文献类型：
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作者：
HINCHLIFFE, SA;LYNCH, MRJ;VANVELZEN, D
目的探讨II型(非对称性)胎儿宫内发育迟缓(IUGR)对肾脏发育的影响。设计前瞻性描述性研究。采用无偏倚、可重复性和基于客观设计的体视学技术对所有受试组的肾脏进行分析。主要结果指标总肾单位(肾小球)数目和总肾单位、皮质和髓质单位肾单位的平均体积。结果在6例生长迟缓死产中，5例肾单位数目低于对照组5%的预测值，且有显著差异(P<；0.005，胎儿宫内发育迟缓为对照均值的65%)。对照组和IUGR组对肾单位(段)体积的估计无差异。结论II型胎儿宫内发育迟缓可能对肾脏发育产生深远影响。出生时肾单位数量的减少，以及在肾单位数量或肾单位大小方面缺乏任何出生后早期补偿，强调了大力产前监测IUGR的必要性，并考虑对受影响的胎儿进行选择性早产。这项工作表明，对宫内晚期以类似快速方式发育的其他器官进行了系统的审查。除了一个例外，生长迟缓组的所有出生体重都在第三百分位数以下，因此进行性宫内发育迟缓与肾功能之间的确切数量关系需要进一步评估。
Objective To investigate the effect of Type II (asymmetrical) intrauterine growth retardation (IUGR) on renal development.Design A prospective descriptive study.Setting Department of Fetal and Infant Pathology, Liverpool Children's Hospital.Subjects Six (severely) affected IUGR stillbirths of known gestational age with a control group of stillbirths with birthweight > 10th centile, and eight liveborn IUGR infants who died within a year of birth with a control group of appropriately grown infants who died within a year of birth (postnatal groups).Techniques The kidneys from all the groups studied were analysed using unbiased, reproducible and objective design-based stereological techniques.Main outcome measures Total renal nephron (glomerular) numbers and average volumes of total nephron and cortical and medullary nephron segments.Results Nephron number estimates lay below the control group's 5% prediction limit in five out of the six growth-retarded stillbirths, and were significantly (P < 0.005, IUGR at 65% of the control mean) reduced in the postnatal group. Estimates of nephron (segment) volume did not differ between control and IUGR groups.Conclusions Type II intrauterine growth retardation may exert a profound effect on renal development. The reduced nephron number at birth, together with the lack of any early postnatal compensation in either nephron number or nephron size, emphasizes the need for vigorous antenatal surveillance for IUGR and consideration of elective preterm delivery of affected fetuses. A systematic review of other organs, which develop in a similarly rapid fashion during the late intrauterine period, is indicated by this work. With one exception, all birthweights in the growth-retarded groups were below the third centile, thus the precise quantitative relation between progressive IUGR and renal function requires further assessment.