Influence of low birth weight on minimal change nephrotic syndrome in children, including a meta-analysis.
BACKGROUND
Low birth weight (LBW) has been shown to lead to a low nephron endowment with subsequent glomerular hyperfiltration. Additional renal disease can therefore be expected to have a more severe course. Minimal change nephrotic syndrome (MCNS) is a common chronic illness in childhood. As it is important to be able to predict prognosis in MCNS, we set out to study the effect of LBW on MCNS in a cohort of patients from our University Medical Center, and performed a meta-analysis.


METHODS
A retrospective chart review of children with MCNS treated at the VU University Medical Center was performed, identifying 55 patients of whom 4 had LBW. The meta-analysis was performed using Review Manager (The Cochrane Collaboration).


RESULTS
The meta-analysis consisted of 201 patients (25 LBW, 176 normal birth weight). More LBW patients were classified as steroid resistant [odds ratio (OR) 6.97 (95% confidence interval [CI] 2.02-24.04), P = 0.002]. The number of relapses per year of follow-up was significantly higher in the LBW patients with MCNS [weighted mean difference 0.93 (95% CI 0.71-1.15) relapse per year, P < 0.0001]. MCNS patients with LBW were significantly more likely to be treated with cyclosporine [OR 4.4 (95% CI 1.7-11.8), P = 0.003] or cytotoxic agents [OR 4.2 (95% CI 1.8-10.2), P = 0.001] during the course of their disease, and they had a higher chance of developing several complications during the follow-up period, including hypertension.


CONCLUSIONS
This meta-analysis provides support for an adverse effect of LBW on the course and prognosis of MCNS in children, which can aid clinicians and parents in assessing the expected clinical course.
Department of Paediatric Nephrology, Erasmus MC-Sophia Children's Hospital, University Medical Centre, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands.
Nynke
N
Teeninga
Michiel F
MF
Schreuder
Arend
A
Bökenkamp
Henriette A
HA
Delemarre-van de Waal
Joanna A E
JA
van Wijk
D002648:Child; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007230:Infant, Low Birth Weight / Q000502:physiology; D007231:Infant, Newborn; D008297:Male; D009402:Nephrosis, Lipoid / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies