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Preterm birth and neonatal acute kidney injury: implications on adolescent and adult outcomes

Journal of Perinatology volume 40, pages 1286–1295 (2020)Cite this article

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Abstract

As a result of preterm birth, immature kidneys are exposed to interventions in the NICU that promote survival, but are nephrotoxic. Furthermore, the duration of renal development may be truncated in these vulnerable neonates. Immaturity and nephrotoxic exposures predispose preterm newborns to acute kidney injury (AKI), particularly in the low birth weight and extremely preterm gestational age groups. Several studies have associated preterm birth as a risk factor for future chronic kidney disease (CKD). However, only a few publications have investigated the impact of neonatal AKI on CKD development. Here, we will review the evidence linking preterm birth and AKI in the NICU to CKD and highlight the knowledge gaps and opportunities for future research. For neonatal intensive care studies, we propose the inclusion of AKI as an important short-term morbidity outcome and CKD findings such as a reduced glomerular filtration rate in the assessment of long-term outcomes.

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Fig. 1: Extremely preterm birth occurs prior to exponential increase in nephron number (adapted from Hinchliffe et al. [24]).
Fig. 2: Exposures across the life course lead to an increased risk of chronic kidney disease in preterm infants.
Fig. 3: Progression from postnatal kidney injury to chronic kidney disease.

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Acknowledgements

The authors would like to acknowledge Drs Robert Chevalier and Frederick Kaskel for their guidance and mentorship.

Funding

KJR is supported by the NIH NIDDK and the Preeclampsia Foundation. JRC is funded by NIH/NIDDK: 1U34DK117128, R01DK111861, R01DK110622.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, University of Wisconsin-Madison, Madison, WI, USA

    Matthew W. Harer

  2. Department of Pediatrics, Division of Nephrology, University of Virginia Children’s Hospital, Box 800386, Charlottesville, VA, USA

    Jennifer R. Charlton

  3. Department of Pediatrics, Section of Neonatal-Perinatal Medicine, University of Oklahoma College of Medicine, Oklahoma City, OK, USA

    Trent E. Tipple

  4. Department of Pediatrics, Division of Pediatric Nephrology, Children’s Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA

    Kimberly J. Reidy

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Harer, M.W., Charlton, J.R., Tipple, T.E. et al. Preterm birth and neonatal acute kidney injury: implications on adolescent and adult outcomes. J Perinatol 40, 1286–1295 (2020). https://doi.org/10.1038/s41372-020-0656-7

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