Kidney volume-to-birth weight ratio as an estimate of nephron endowment in extremely low birth weight preterm infants

Abstract

In humans, nephrogenesis is completed by 32-36 weeks gestation, with a highly variable total number of nephrons, ranging from 200,000 to over 2 million. Premature birth disrupts the development and maturation of the kidneys, leading to a reduction in the final number of nephrons. Due to significant genetic variability in the number of nephrons among individuals, it is crucial to identify premature infants with fewer nephrons at birth as early as possible. These infants are more susceptible to developing renal failure with advancing age compared to those with a higher nephron endowment. Bedside ultrasound, an effective and non-invasive tool, is practical for identifying newborns with a lower nephron count. However, renal volume alone cannot reliably indicate the number of nephrons due to substantial variability at birth, influenced by gestational age when nephron maturation is incomplete. This variability in kidney volumes persists as newborns grow. In this observational study we hypothesize that the relationship between renal volume and birth weight may serve as an indicator of nephron endowment in premature infants with birth weight less than 1000 g. This finding could represent the basis for defining appropriate surveillance protocols and developing targeted therapeutic approaches.

Figure 1

Relationship between combined renal volume (right renal volume + left renal volume) in cubic centimeters and body weight in grams of preterm infants with a birth weight of less than 1000 g from 1 week after birth to 38–40 weeks of post-menstrual age. Correlation coefficient r_s = 0.8321, p < 0.001.

Figure 2

Relationship between combined renal volume (right renal volume + left renal volume) in cubic centimeters and body length in centimeters of preterm infants with a birth weight of less than 1000 g from 1 week after birth to 38–40 weeks post-menstrual age. Correlation coefficient r_s = 0.7339, p < 0.001.

Figure 3

Relationship between combined renal volume (right renal volume + left renal volume) in cubic centimeters and body weight in grams of preterm infants with a birth weight of less than 1000 g from 38 to 40 weeks post-menstrual age to 24 months post-menstrual age. Correlation coefficient r_s = 0.8837, p < 0.001.

Figure 4

Relationship between combined renal volume (right renal volume + left renal volume) in cubic centimeters and body length in centimeters of preterm infants with a birth weight of less than 1000 g from 38 to 40 weeks post-menstrual age to 24 months post-menstrual age. Correlation coefficient r_s = 0.8493, p < 0.001.