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  • Review Article
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The long-term renal and cardiovascular consequences of prematurity

Nature Reviews Nephrology volume 8, pages 265–274 (2012)Cite this article

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Abstract

Infants born prematurely at <37 weeks' gestation account for over 80% of infants weighing <2,500 g at birth—low birth weight (LBW) infants. This designation remains the surrogate marker for developmental origins of adult disease. Landmark studies spanning four decades have shown that individuals born with a LBW are more likely to develop cardiovascular and renal disease in later life, which is believed to be related to 'developmental programming' of such adult disease during vulnerable periods of growth in utero and in the early postnatal period. There has long been ambiguity regarding the distinction between infants with intrauterine growth restriction and preterm infants since both show a low nephron endowment that is associated with subsequent hypertension and chronic kidney disease. Knowledge is growing specific to the preterm infant and the developmental associations of being born preterm with the interruption of normal organogenesis relative to the vascular tree and kidney. Both systems develop by branching morphogenesis and interruptions lead to considerable deficits in their structure and function. These developmental aberrations can lead to endothelial dysfunction, hypertension, proteinuria and metabolic abnormalities that persist throughout life. This Review will examine the effect of preterm birth on the development of cardiovascular and kidney disease in later life and will also discuss potential early interventions to alter the progression of disease.

Key Points

  • Prematurely born infants account for >80% of infants born with a low birth weight (<2,500 g), which has become a surrogate marker for an increased risk of developing cardiovascular and renal disease in later life

  • Preterm birth is associated with interruption of the normal organogenesis of the kidney and the vascular tree, leading to low nephron endowment, hypertension, endothelial dysfunction and proteinuria in some individuals

  • Ethnic minorities are at increased risk of preterm birth, with African Americans having a prevalence three times that of white individuals

  • Progressive kidney disease in preterm individuals is multidimensional, with genetic and environmental events contributing to the programming of subsequent risks of cardiovascular and renal disease

  • Prospective observational and early intervention trials directed towards modulating catch-up growth, preventing obesity and identifying and treating hypertension, proteinuria and hyperuricemia, are warranted

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Figure 1: A multidimensional scheme showing the effects that preterm birth can have on the risks of cardiovascular and renal disease in later life.
Figure 2: Photomicrographs of progressive renal development.
Figure 3: Composite photomicrograph showing renal parenchyma from a child born extremely preterm who survived for more than 40 days and developed renal failure.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, P. O. Box 016960 (M-714), Miami, 33101, FL, USA

    Carolyn L. Abitbol

  2. Division of Pediatric Pathology, Department of Pediatrics, Holtz Children's Hospital, University of Miami Miller School of Medicine, P. O. Box 016960 (M-714), Miami, 33101, FL, USA

    Maria M. Rodriguez

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  1. Carolyn L. Abitbol
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  2. Maria M. Rodriguez
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The authors contributed equally to all aspects of this manuscript.

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Correspondence to Carolyn L. Abitbol.

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The authors declare no competing financial interests.

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Abitbol, C., Rodriguez, M. The long-term renal and cardiovascular consequences of prematurity. Nat Rev Nephrol 8, 265–274 (2012). https://doi.org/10.1038/nrneph.2012.38

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