Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease
Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease
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DOI：
10.1542/peds.2013-0009
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发表时间：
2013-06-01
期刊：
影响因子：
8
通讯作者：
Charlton, Jennifer R.
中科院分区：
文献类型：
--
作者：
Carmody, J. Bryan;Charlton, Jennifer R.
由于新生儿重症监护的显著进步，曾经几乎没有生存机会的婴儿现在可以进入成年。然而，早产或低出生体重(LBW)对肾脏发生、最终肾单位数量和长期肾功能的影响尚不清楚。这篇综述集中于理论、实验证据和观察数据，这些数据表明早产儿患慢性肾脏疾病(CKD)的风险增加。许多早产儿和LBW婴儿出生时未成熟的肾单位不完全补充。然后，他们暴露在各种外部应激源中，这些应激因素可能会阻碍肾脏的持续发育或导致额外的肾单位丧失，如血流动力学改变、肾毒性药物、感染和不理想的营养。尤其是急性肾损伤，可能是CKD发生的重要危险因素。根据Brenner的假设，肾单位数量减少的患者会发展成高滤过，导致钠滞留、高血压、肾单位丧失，以及继发性局灶节段性肾小球硬化所致的CKD。由于早产儿和低出生体重儿患慢性肾脏病的风险尚未被准确确定，因此没有循证的筛查或治疗建议。然而，由于表面活性物质时代的第一代婴儿现在才成年，CKD可能已经存在一种未被认识到的流行病。我们建议对早产儿和LBW婴儿进行个体化、基于风险的评估，因为CKD的风险增加，并呼吁对这些婴儿面临的CKD的长期风险进行额外的研究。
Thanks to remarkable advances in neonatal intensive care, infants who once had little chance for survival can now enter adulthood. Yet the consequences of premature birth or low birth weight (LBW) on nephrogenesis, final nephron number, and long-term kidney function are unclear. This review focuses on the theory, experimental evidence, and observational data that suggest an increased risk of chronic kidney disease (CKD) for infants born prematurely. Many premature and LBW infants begin life with an incomplete complement of immature nephrons. They are then exposed to a variety of external stressors that can hinder ongoing kidney development or cause additional nephron loss such as hemodynamic alterations, nephrotoxic medications, infections, and suboptimal nutrition. Acute kidney injury, in particular, may be a significant risk factor for the development of CKD. According to Brenner's hypothesis, patients with decreased nephron number develop hyperfiltration that results in sodium retention, hypertension, nephron loss, and CKD due to secondary focal segmental glomerulosclerosis. Because the risk of CKD in premature and LBW infants has not been accurately determined, there are no evidence-based recommendations for screening or management. Yet with the first generation of infants from the surfactant era only now reaching adulthood, it is possible that there is already an unrecognized epidemic of CKD. We suggest individualized, risk-based assessments of premature and LBW infants due to the increased risk of CKD and call for additional research into the long-term risk for CKD these infants face.