Effect of Fetal and Child Health on Kidney Development and Long-Term Risk of Hypertension and Kidney Disease

Perspective:

The following are 10 points to remember regarding this review on the impact of fetal and child health on long-term outcomes of kidney disease and hypertension:

1. Neonatal issues of low birthweight (defined as birthweight <2.5 kg) and prematurity (defined as an infant born before 37 weeks of gestation) are risk factors for hypertension, proteinuria, and chronic kidney disease later in life.

2. Prematurity and low birthweight are associated with reduction in nephron number. Decreased nephron number has been found to be associated with increased blood pressure and predilection to kidney disease.

3. Calculations of total nephron number have been obtained from autopsy specimens. There are wide variations in nephron number within various populations. Total nephron number varies inversely with mean glomerular volume.

4. Prematurity occurs at a worldwide frequency of 9.6% of livebirths, while low birthweight occurs at a frequency of 15%. Therefore, a large proportion of children worldwide are at risk of hypertension and renal disease.

5. Some cases of prematurity and low birthweight can be impacted by prenatal care including optimization of maternal nutrition, which could result in significant long-term health benefits.

6. Maternal smoking has been associated with low birthweight and low nephron number.

7. Vitamin A intake may be an important determinant of nephron number, as retinoic acid (the active metabolite of vitamin A) regulates the transcription of RET, a tyrosine kinase receptor involved with renal development.

8. In addition to low birthweight and prematurity, high birthweight, particularly when a result of maternal diabetes, is associated with increased risk of proteinuria and kidney disease later in life.

9. Upward crossing of weight or body mass index (BMI) percentiles in infancy (<1 year of age) does not significantly impact later blood pressure, and may be protective against diabetes.

10. For older children and adolescents, upward crossing of weight or BMI percentiles is associated with increased risk of adult hypertension, type 2 diabetes, and cardiovascular disease.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Prevention, CHD & Pediatrics and Prevention, CHD & Pediatrics and Quality Improvement, Hypertension, Smoking

Keywords: Birth Weight, Diabetes Mellitus, Type 2, Maternal Nutritional Physiological Phenomena, Risk Factors, Blood Pressure, Proteinuria, Kidney Glomerulus, Autopsy, Smoking, Diabetes, Gestational, Receptor, trkA, Kidney Diseases, Body Composition, Body Mass Index, Vitamin A, Prenatal Care, Cardiovascular Diseases, Infant, Low Birth Weight, Hypertension, Diabetes Mellitus, Renal Insufficiency, Chronic


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