Obesity and preterm birth: additive risks in the progression of kidney disease in children
Obesity and preterm birth: additive risks in the progression of kidney disease in children
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DOI：
10.1007/s00467-009-1120-2
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发表时间：
2009-07-01
影响因子：
3
通讯作者：
Zilleruelo, Gaston
中科院分区：
文献类型：
--
作者：
Abitbol, Carolyn L.;Chandar, Jayanthi;Zilleruelo, Gaston
早产与肾单位质量减少和肥胖相关，这可能会影响晚年肾脏疾病的进展。我们的目的是研究肥胖和早产对儿童肾脏疾病进展的相对风险。在一项回顾性队列研究中，研究了80例（44例肥胖和36例非肥胖）蛋白尿性肾病患者的疾病进展和肾小球组织形态计量学。在肥胖者中，22人是足月出生（肥胖-T），22人是早产（肥胖-PT）。17名非肥胖的局灶性肾小球硬化症儿童，足月出生（NO-FSGS），和19名非肥胖的早产儿（NO-PT），作为对照。通过稳态模型评估（HOMA-IR）测量的胰岛素抵抗在所有肥胖儿童中均升高。与肥胖-T儿童相比，肥胖-PT患者儿童期肾死亡风险增加[风险比2.4; 95%置信区间（95% CI）1.1至7.1; P = 0.04]。在肥胖儿童中，尽管蛋白尿经常超过肾病范围，但血清白蛋白的平均水平保持正常。早产儿更可能有肾质量减少（比值比4.7; P = 0.006），但肥胖不是一个因素。肾组织形态计量学显示，无论出生体重如何，肥胖患者都有肾小球肿大。肥胖和早产似乎增加了儿童期肾脏疾病进展的风险。
Preterm birth is associated with decreased nephron mass and obesity that may impact on kidney disease progression in later life. Our objectives were to examine the relative risks of obesity and preterm birth on the progression of kidney disease in children. In a retrospective cohort study, 80 (44 obese and 36 non-obese) patients with proteinuric kidney disease were studied for disease progression and glomerular histomorphometry. Of the obese, 22 had been born at term (Obese-T) and 22 had been preterm (Obese-PT). Seventeen non-obese children with focal glomerular sclerosis, born at term (NO-FSGS), and 19 non-obese preterm (NO-PT) children, served as controls. Insulin resistance as measured by the homeostatic model assessment (HOMA-IR) was elevated in all obese children. Obese-PT patients had increased risk of renal demise during childhood when compared with Obese-T children [hazard ratio 2.4; 95% Confidence interval (95% CI) 1.1 to 7.1; P = 0.04]. In obese children, although proteinuria often exceeded nephrotic range, average levels of serum albumin remained normal. Preterm patients were more likely to have reduced renal mass (odds ratio 4.7; P = 0.006), but obesity was not a factor. Renal histomorphometry showed glomerulomegaly in obese patients, regardless of birth weight. Obesity and preterm birth appear to impose additive risks for progression of kidney disease in childhood.