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Kidney Week

Abstract: TH-PO763

Catch-Up Growth but Not Growth Hormone Itself Is Associated with Renal Injury in Subjects Born Small for Gestational Age

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Awazu, Midori, Keio University School of Medicine, Tokyo, Japan
  • Shibata, Hironori, Keio University School of Medicine, Tokyo, Japan
  • Hida, Mariko, Keio University School of Medicine, Tokyo, Japan
  • Ishii, Tomohiro, Keio University School of Medicine, Tokyo, Japan
  • Hasegawa, Tomonobu, Keio University School of Medicine, Tokyo, Japan
  • Matsumura, Kazuya, Keio University School of Medicine, Tokyo, Japan
Background

Subjects born with low birth weight including those born small for gestational age (SGA) are at a risk for developing hypertension and chronic kidney disease due to reduced nephron number. Growth hormone (GH), given to SGA children without catch-up growth, can induce hyperfiltration leading to glomerulosclerosis. Catch-up growth may also be a risk factor of kidney disease. We investigated the effects of GH and catch-up growth in the development of renal injury in subjects born SGA.

Methods

Twenty-eight subjects (12 males and 16 females, age 4 to 27 years) born SGA were retrospectively investigated. Twenty-three were preterm-SGA, and 4 out of 5 term-SGA were syndromic. Fourteen subjects were treated with GH. Estimated GFR (eGFR) was determined by quintic equation for Japanese children (<19 years) or formulas for Japanese adults (≥19 years) by age and gender. Renal injury was defined as reduced eGFR <90 ml/min/1.73 m2, elevated urine microalbumin/creatinine ratio (malb/Cr) ≥30 mg/g, or the presence of hypertension. Catch-up growth was defined as change in SD score in height or weight from birth to the time when the final height was achieved or to the time of study for those who have not reached final height.

Results

There was no difference in current age, gestational age, birth weight, eGFR, malb/Cr, renal injury, height catch-up, or weight catch-up between subjects treated with GH and those not treated with GH (Table).
Of all subjects, there was no cut-off SD score of height catch-up that separates those with and without renal injury. On the other hand, 12 out of 16 subjects (75%) with weight catch-up ≥1.6 SD had renal injury, whereas only 2 out of 11 (18%) with weight catch-up <1.6 SD had renal injury (P<0.05). On ROC analysis, a cut-off value of 1.595 SD in weight catch-up best predicted renal injury with 86% sensitivity and 62% specificity.

Conclusion

There was no difference in the prevalence of renal injury between SGA subjects treated with GH and those not treated with GH probably because the latter had spontaneous catch-up growth. Weight catch-up ≥1.6 SD appears to be a risk factor for renal injury.

GHAge
(yr)
Gestational
age (wk)
Birth weight
(g)
eGFR (ml/min/
1.73 m2)
malb/Cr
(mg/g)
Renal
injury
Height
catch-up
Weight
catch-up
+11.3
(5.5)
30.5
(6.6)
1060
(759)
98.3
(24.6)
6.6
(3.0)
8/140.97
(0.94)
1.62
(0.72)
-13.1
(4.4)
28.1
(2.9)
700
(199)
92.6
(13.4)
40.4
(78.6)
7/141.48
(1.48)
2.05
(0.86)

+, treated: -, not treated. Mean (SD).

Funding

  • Government Support - Non-U.S.