Renal consequences of prematurity and utility of serum uromodulin as a marker of kidney growth- a cross sectional single centre study

Prematurity has been postulated to have adverse effects on nephron endowment. The objectives of the study was to study the kidney consequences of prematurity in childhood. We also studied the serum uromodulin levels in children with premature birth and its correlation with kidney growth. This cross-sectional study was conducted from January to December 2019 included children aged 3 to 6 years with history of premature birth from 2014 to 2016. Impact of prematurity on clinical parameters such as growth, blood pressure, kidney volume were studied. In addition serum uromodulin estimated by enzyme linked immunoassay kit was used to correlate with mean kidney volume (MKV), hypertension and chronic kidney disease (CKD). In this single centre cross-sectional study outcomes of 37 children with history of prematurity were analysed. Median (IQR) age of the cohort was 5.8 years(4 to 6.6). The mean (SD) gestational age of the cohort was 30 (2) weeks with mean (SD) birth weight of 1359.7 g(333.8). Premature rupture of membranes(12/3,32.4%) and pregnancy induced hypertension(9/37,24.3%) were common antenatal risk factors.On follow up 21.6%(8/37) had elevated BP and hypertension, 2.7%(1/37) had CKD. Serum uromodulin levels upto 100ng/ml had significant association with lower MKV(p value 0.002), with cut off value of < 52ng/ml was significantly associated with lower MKV(< 32 ml)with AUC by ROC of 0.715, sensitivity of 87% and specificity of 55%(p value 0.02). Prematurity is noted to have impact on renal health with risk of hypertension, lower kidney volume and CKD in childhood. In addition serum uromodulin level is significantly associated with lower mean kidney volume in children with premature birth.