早產和腎臟健康：慢性腎臟病的風險增加
摘要
文獻回顧目的——本次文獻回顧的目的是描述早產在慢性腎病
(CKD) 的發展，並討論這種關聯的潛在原因。包括腎元減少，以及產後損傷，如新生兒急性腎病損傷（nAKI）。
最新發現——新近的人類和動物實驗研究加強了早產、低出生體重和慢性腎病之間的關聯。越來越多的證據顯示，出生時腎元數量減少易引起的慢性腎病 (主文中提及早產兒的腎元數較足月兒少)
。兒童期，少的腎元數一開始可能只會導致輕微異常。但到青春期或成年時會導致慢性腎病、高血壓和蛋白尿。最近研究發現，早產兒的新生兒急性腎病損傷的發生率很高，這也可能導致持續的慢性腎病風險。
總結——低體重嬰兒（由於早產和/或子宮內生長受限）於成年期腎功能障礙的風險增加。了解早產兒腎元數及子宮外環境是必須及重要的。此外，提高對高風險嬰兒的認識及腎功能障礙的早期評估和檢測也很重要，以干預減緩其進展為慢性腎病。
Purpose of review—The
purpose of this review is to describe the role prematurity plays in the development
of chronic kidney disease (CKD), and to discuss potential reasons for this
association including decreased nephron mass, as well as post-natal insults
such as neonatal acute kidney injury (nAKI).
Recent findings—New observational studies
in humans and experimental studies in animal models have strengthened the
association between prematurity, low birth weight, and CKD. Growing evidence
suggests increased susceptibility to CKD is caused by decreased nephron mass at
birth. Beginning with a low nephron count may cause only subtle abnormalities
during childhood, however may result in CKD, hypertension and albuminuria in
adolescence or adulthood. Recent studies in premature infants reveal a high
incidence of nAKI, which may also contribute to ongoing CKD risk.
Summary—Children born at low birth weights
(both due to prematurity and/or intrauterine growth restriction) show increased
risk of kidney dysfunction during adulthood. A better understanding of the
modulators of nephron mass in premature infants as well as the effects of the extrauterine
environment is essential. Additionally, improved awareness of at-risk infants
is important as is early evaluation and detection of kidney dysfunction,
allowing interventions to slow the progression to CKD.
參考資料
Prematurity and Future
Kidney Health: The Growing Risk of Chronic Kidney Disease
Curr Opin Pediatr. 2018 Apr; 30(2): 228–235. doi: 10.1097/MOP.0000000000000607
留言
張貼留言