Maternal Obesity Linked to Chronic Kidney Disease Risk in Children -

Chronic kidney disease (CKD) has been recognized as a serious medical problem for about two hundred years. Until recent times, chronic kidney disease was always fatal. Medical and technological advances in the second half of the 20th century have made CKD manageable for most victims if the condition is diagnosed early. The impact of these medical advances has been revolutionary.

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Nevertheless, in the last two decades, the incidence of chronic kidney disease in children has steadily increased, with poor and ethnic minority children suffering disproportionately. Can efforts to prevent chronic kidney disease in children be made even before a child is born? Apparently, the answer is yes. Everyone knows that healthy mothers tend to give birth to healthy babies and that unhealthy moms tend to give birth to unhealthy children. In the case of childhood chronic kidney disease, maternal obesity has a substantial impact on fetal health. That’s the finding that was published in 2014 in the Journal of the American Society of Nephrology.

Christine Hsu, M.D., and other researchers at the University of Washington’s Department of Nephrology published their research results in 2014 in the Journal of the American Society of Nephrology. They evaluated almost two thousand patients diagnosed with CKD from 1987 to 2008. The researchers concluded their findings by saying “children with CKD were significantly more likely to have obese mothers; thus our data underscores the potential impact of maternal obesity on future generations.”

DOES RECENT KIDNEY DISEASE RESEARCH CONFIRM EARLIER FINDINGS?

More recent research was presented in June 2016 at the American Diabetes Association 76th Scientific Sessions in New Orleans. Australian researchers fed female mice either regular chow or high-fat diet (45 percent fat) for six weeks before they conceived, and the diets continued through the gestation and lactation periods. The male offspring were either given regular chow or high-fat diet as well. The team measured the weight and glucose levels of the mice biweekly, and at weeks 14, 20, and 30; they performed intraperitoneal glucose tolerance tests. Urine and serum samples were also collected, and then at 32 weeks, the kidneys were harvested.

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Offspring fed the high fat diet showed increased fat disposition, insulin resistance, and impaired glucose tolerance. Where the mother was obese, the offspring fed the high-fat diet experienced exaggerated adiposity dyslipidemia (elevation of plasma cholesterol), and glucose intolerance. Researchers found renal fibrosis, tubular interstitial fibrosis, dilatation, and vacuolation. Albuminuria (albumin present in urine) is another indication of chronic kidney disease, but in the Australian study, it appeared unaffected by maternal obesity. Serum creatinine, however, increased in the offspring of obese mothers – even those fed the normal chow.

“Though maternal obesity had a sustained deleterious effect on adiposity, metabolic measures, serum creatinine, and renal oxidative stress in lean offspring, the renal consequences of maternal obesity were overridden by the powerful effect of diet-induced obesity,” the researchers explained. “Therefore, we suggest that maternal obesity portends significant risks for metabolic and renal health in adult offspring, however, diet-induced obesity is an overwhelming and potent stimulus for the development of CKD that is not potentiated by maternal obesity.”

HOW IS OBESITY DEFINED?

Based on their findings, the researchers believe that fetal exposure to maternal obesity should be clinically recognized as a considerable risk factor for CKD in the child. Obesity is defined as having a Body Mass Index (BMI) of 30 or greater. The BMI is determined by dividing the body mass by the square of the body height. A 5-foot-5-inch tall woman is considered obese if she weighs 180 pounds or more, and a 5-foot-8-inch tall woman is considered obese if she weighs 200 pounds or more.

Maternal obesity disrupts glucose homeostasis, insulin resistance, fat oxidation, and amino acid synthesis. Lifestyle changes can improve the maternal metabolism and help to prevent adverse outcomes such as CKD. There are many options for treating obesity, such as diet changes and regular exercise. Moderate exercise such as walking or bicycling can lead to healthy weight loss. Some choose gastric bypass surgery to reduce the appetite. Always consult a physician before starting any obesity treatment. While obese women should try to lose weight before a pregnancy, women should not diet during pregnancy because sufficient nutrition is vital for the offspring.

If untreated, chronic kidney disease progresses to kidney failure, and it also increases the risk for cardiovascular disease. Evidence-based clinical practice guidelines recommend early recognition and treatment for CKD-related complications to enhance the development, growth, and quality of life for children with chronic kidney disease. Appropriate pediatric care can reduce the prevalence of this complex and expensive condition.

CAN CHRONIC KIDNEY DISEASE BE HALTED OR REVERSED?

Whether you seek kidney disease treatment for yourself or for your child, you should know that most kidney diseases can be managed, and the progression from early-stage kidney disease to full renal failure can be slowed, stopped, and sometimes even reversed. However, if lab test results are misread or not even recognized – because of inadequate medical training, overwork, and stress, or any other reason – specialists may not be consulted, treatment may not be ordered, and a patient’s condition can quickly deteriorate. That constitutes medical malpractice.

If a urine test indicates that blood and protein – “proteinuria” and “hematuria” – are present in the urine, these typically indicate kidney disease, and retesting should be ordered after a brief interval. If the retest shows the same levels of protein and blood, a specialist should be seen. If a blood test measures a lowered protein level in the blood, increased creatinine, and an abnormal blood urea nitrogen (BUN) level, the kidneys may not be properly filtering the blood, and more tests should be ordered.

General practitioners may not have a specialist’s training, but they should know when a patient needs to be seen by a specialist. Medical malpractice is very precisely defined. It is the violation of the “reasonable standard of care” that most doctors provide, but every medical malpractice case is unique, and every allegation must be thoroughly examined from legal and medical perspectives with the help of an experienced medical malpractice attorney.

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Medical malpractice in the United States is more frequent than many people realize. Every day in this country, innocent people are injured because a healthcare provider has been careless or negligent. Medical malpractice can result in catastrophic injuries, lifelong disability, or even death. If someone is a kidney disease sufferer, and if the improper treatment or inaccurate diagnosis of kidney disease has caused a deterioration of health, it’s important to speak with an experienced medical malpractice attorney regarding the patient’s legal rights and options.

By: Jed Kurzban

Medical malpractice attorney Jed Kurzban graduated from the University of Alabama in 1992 and earned his Juris Doctor from the University of Miami School of Law in 1995. He is a member of the Dade County Bar Association, the Florida Bar Association, the American Association for Justice, the Academy of Florida Trial Lawyers, and the American Bar Association. Mr. Kurzban is happily married and the father of two.