From an epidemiological perspective, the global incidence of preterm births has witnessed a steady rise worldwide, currently estimated at about 10%.¹ With the improving survival rates of premature and low birth weight (LBW) newborns, the global incidence of Chronic Kidney Disease (CKD) requiring dialysis and renal transplant in both pediatric and, more significantly, adult population is destined to increase.² This trend represents also a significant burden on healthcare systems, particularly in low and middle-income countries (LMIC).

It is well established that prematurity disrupts the typical trajectory of renal organogenesis. As the number of nephrons at birth is proportional to gestational age, preterm newborns have a reduced nephron endowment. Moreover, a growth deficit in the perinatal period, due to impaired nutrition, seems to reduce nephron number³ and the incompletely developed kidneys, frequently subjected to stressful conditions inherent to prematurity and hospitalization, such as hemodynamic instability, infectious episodes, and exposure to nephrotoxic medications, may suffer from further nephron loss. This succession of hits finally leads to an increased risk of CKD and hypertension, which, although extensively documented, remains incompletely quantified and likely underestimated. Yet, recent meta-analyses showed that LBW confers a 70% increased risk of CKD, defined by proteinuria, decreased glomerular filtration rate (GFR) or end-stage kidney disease (ESKD, compared to normal birth weight.⁴ Similarly, preterm birth has been associated with lower GFR and higher albuminuria in young adults, with an estimated risk among US adolescents of one individual with reduced GFR and one with increased systolic blood pressure for every 13 born at low birth weight.⁵

从流行病学角度来看，全球早产发生率稳步上升，目前估计约为10%。¹随着早产儿和低出生体重 (LBW) 新生儿存活率的提高，全球儿童以及更重要的是成人中需要透析和肾移植的慢性肾病 (CKD) 发病率注定会增加。²这一趋势也给医疗保健系统带来了沉重负担，特别是在低收入和中等收入国家 (LMIC)。

众所周知，早产会破坏肾器官发生的典型轨迹。由于出生时肾单位的数量与胎龄成正比，因此早产儿的肾单位数量减少。此外，由于营养受损，围产期的生长缺陷似乎会减少³号肾单位和发育不完全的肾脏，经常遭受早产和住院固有的压力条件，例如血流动力学不稳定、感染发作和接触肾毒性物质药物治疗，可能会导致肾单位进一步损失。这一系列的打击最终导致 CKD 和高血压的风险增加，虽然有大量记录，但仍然不完全量化，并且可能被低估。然而，最近的荟萃分析表明，与正常出生体重相比，低出生体重会使患 CKD 的风险增加 70%，慢性肾病的定义是蛋白尿、肾小球滤过率 (GFR) 下降或终末期肾病 (ESKD)。4^同样，早产与年轻人中较低的 GFR 和较高的蛋白尿有关，据估计，在美国青少年中，每 13 名低出生体重儿出生的人中，就有 1 名 GFR 降低和 1 名收缩压升高的风险^。5