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Early post-natal nutrition and renal consequences in preterm infants

Pediatric Research (2024)Cite this article

From an epidemiological perspective, the global incidence of preterm births has witnessed a steady rise worldwide, currently estimated at about 10%.1 With the improving survival rates of premature and low birth weight (LBW) newborns, the global incidence of Chronic Kidney Disease (CKD) requiring dialysis and renal transplant in both pediatric and, more significantly, adult population is destined to increase.2 This trend represents also a significant burden on healthcare systems, particularly in low and middle-income countries (LMIC).

It is well established that prematurity disrupts the typical trajectory of renal organogenesis. As the number of nephrons at birth is proportional to gestational age, preterm newborns have a reduced nephron endowment. Moreover, a growth deficit in the perinatal period, due to impaired nutrition, seems to reduce nephron number3 and the incompletely developed kidneys, frequently subjected to stressful conditions inherent to prematurity and hospitalization, such as hemodynamic instability, infectious episodes, and exposure to nephrotoxic medications, may suffer from further nephron loss. This succession of hits finally leads to an increased risk of CKD and hypertension, which, although extensively documented, remains incompletely quantified and likely underestimated. Yet, recent meta-analyses showed that LBW confers a 70% increased risk of CKD, defined by proteinuria, decreased glomerular filtration rate (GFR) or end-stage kidney disease (ESKD, compared to normal birth weight.4 Similarly, preterm birth has been associated with lower GFR and higher albuminuria in young adults, with an estimated risk among US adolescents of one individual with reduced GFR and one with increased systolic blood pressure for every 13 born at low birth weight.5

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Authors and Affiliations

  1. Pediatric Nephrology, Dialysis and Transplant Unit, IRCCS Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milano, Italy

    Alberto Edefonti & Maria Cristina Mancuso

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  1. Alberto Edefonti
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  2. Maria Cristina Mancuso
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A.E. and M.C.M. conceptualized and wrote the manuscript.

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Correspondence to Alberto Edefonti.

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Edefonti, A., Mancuso, M.C. Early post-natal nutrition and renal consequences in preterm infants. Pediatr Res (2024). https://doi.org/10.1038/s41390-024-03174-8

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