Perinatal factors contributing to chronic kidney disease in a cohort of Japanese children with very low birth weight
PEDIATRIC NEPHROLOGY
Authors: Uemura, Osamu; Ishikura, Kenji; Kaneko, Tetsuji; Hirano, Daishi; Hamasaki, Yuko; Ogura, Masao; Mikami, Naoaki; Gotoh, Yoshimitsu; Sahashi, Takeshi; Fujita, Naoya; Yamamoto, Masaki; Hibino, Satoshi; Nakano, Masaru; Wakano, Yasuhiro; Honda, Masataka
Abstract
Background Developmental programming of chronic kidney disease (CKD) in young adults is linked to preterm birth and intrauterine growth restriction (IUGR). Which confers a higher risk of progression to chronic kidney damage in children with very low birth weight (VLBW; born weighing < 1500 g): prematurity or IUGR? Methods This is a national historical cohort study of children with VLBW cared for in perinatal medical centers in Japan. Predictive factors included three latent variables (prematurity, IUGR, stress during neonatal period) and eight observed variables (gestational age, birth weight Z-score, maternal age, duration of treatment with antibiotics and diuretics, maternal smoking, late-onset circulatory collapse, kidney dysfunction) during the perinatal period. The primary endpoint was estimated glomerular filtration rate (eGFR) at age >= 3 years. A structural equation model was used to examine the pathologic constitution. Results The 446 children with VLBW included 253 boys and 193 girls, of mean age 5.8 +/- 2.6 years and mean eGFR 111.7 ml/min/1.73 m(2)at last encounter. Pathway analyses showed intrauterine malnutrition (beta= 0.85) contributed more to chronic kidney damage than stress during the neonatal period (beta= - 0.19) and prematurity (beta= 0.12), and kidney dysfunction and late-onset circulatory collapse were important observed variables in stress during the neonatal period. Conclusions IUGR was more harmful to future kidneys of VLBW neonates. Neonatal kidney dysfunction and late-onset circulatory collapse were important risk factors for subsequent CKD development. This emphasizes the need for obstetricians to monitor for fetal growth restriction and neonatologists to minimize neonatal stress to prevent CKD in later life.
Early clinical factors predicting the development of critical disease in Japanese patients with COVID-19: A single-center, retrospective, observational study
JOURNAL OF MEDICAL VIROLOGY
Authors: Higuchi, Takatoshi; Nishida, Tsutomu; Iwahashi, Hiromi; Morimura, Osamu; Otani, Yasushi; Okauchi, Yukiyoshi; Yokoe, Masaru; Suzuki, Norihiro; Inada, Masami; Abe, Kinya
Abstract
The factors predicting the progression of coronavirus disease-2019 (COVID-19) from mild to moderate to critical are unclear. We retrospectively evaluated risk factors for disease progression in Japanese patients with COVID-19. Seventy-four patients with laboratory-confirmed COVID-19 were hospitalized in our hospital between February 20, 2020, and June 10, 2020. We excluded asymptomatic, non-Japanese, and pediatric patients. We divided patients into the stable group and the progression group (PG; requiring mechanical ventilation). We compared the clinical factors. We established the cutoff values (COVs) for significantly different factors via receiver operating characteristic curve analysis and identified risk factors by univariate regression. We enrolled 57 patients with COVID-19 (median age 52 years, 56.1% male). The median time from symptom onset to admission was 8 days. Seven patients developed critical disease (PG: 12.2%), two (3.5%) of whom died; 50 had stable disease. Univariate logistic analysis identified an elevated lactate dehydrogenase (LDH) level (COV: 309 U/l), a decreased estimated glomerular filtration rate (eGFR; COV: 68 ml/min), lymphocytopenia (COV: 980/mu l), and statin use as significantly associated with disease progression. However, in the Cox proportional hazards analysis, lymphocytopenia at admission was not significant. We identified three candidate risk factors for progression to critical COVID-19 in adult Japanese patients: statin use, elevated LDH level, and decreased eGFR.
COA
Publication 
1.jpg)
Loading ......
