The Chronicle of a Renal Death Foretold

Case report

At the age of 27 years, PJ presented with fatigue, pallor, malaise, nocturia, mild hypertension and proteinuria (75 g/mol creat.). The plasma creatinine was elevated (180 µmol/l). Childhood had been uneventful a difficult birth. He was indeed born premature (29 weeks GA), and small for gestational age (920 g). He had presented with severe RDS, transient renal failure and a patent ductus arteriosus in his first days of life. He had left the neonatal unit with apparent normal kidney function (P-creat. 50 µmol/l). At the age of 3 years, the pediatrician had found normal growth (25th percentile) and normal urinalysis. The diagnosis of chronic renal failure at the age of 27 years was a surprise for the patient, his parents and the general practitioner. The intriguing following question was thus asked: In this case, was the renal failure at the age of 27 years already foretold at birth?