Albuminuria and sodiuria in IUGR children

Objective: Intrauterine growth restriction (IUGR) is associated with hyperfiltration, glomerulosclerosis and albuminuria. Albuminuria may further lead to tubulointerstitial inflammation, fibrosis and tubular atrophy. The time at which this may occur is unknown. This study was designed to assess the relationship between glomerular and tubular damage in IUGR children. Methods: We enrolled 50 children, 25 IUGR, categorized by estimated fetal weight <10th percentile and umbilical artery pulsatility index >2 SD, and 25 appropriate for gestational age (AGA) controls at 18 months of age. We compared albuminuria among IUGR and AGA children, to assess the relationship between albuminuria and contemporary sodium and lysozyme excretion, as a measure of tubular damage. Results: The albumin-creatinine (mg/g) and sodium-creatinine (μM/L) ratios (3.12 and 441.3, versus 1.39 and 226.1 in AGA; p=0.002 and p=0.012, respectively) were significantly higher in the IUGR subjects compared with AGA children, and significantly correlated (rho=0.593, p=0.002). Conversely, urinary lysozyme was undetectable or in normal excretion range. Conclusions: Our results show glomerulosclerosis and albuminuria in IUGR children aged 18 months. Elevated sodium excretion in the absence of abnormal lysozymuria may represent a epiphenomenon of glomerulosclerosis and of albuminuria.