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Bishop AC, Spradling‐Reeves KD, Shade RE, Lange KJ, Birnbaum S, Favela K, Dick EJ, Nijland MJ, Li C, Nathanielsz PW, Cox LA. Postnatal persistence of nonhuman primate sex-dependent renal structural and molecular changes programmed by intrauterine growth restriction. J Med Primatol 2022; 51:329-344. [PMID: 35855511 PMCID: PMC9796938 DOI: 10.1111/jmp.12601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Poor nutrition during fetal development programs postnatal kidney function. Understanding postnatal consequences in nonhuman primates (NHP) is important for translation to our understanding the impact on human kidney function and disease risk. We hypothesized that intrauterine growth restriction (IUGR) in NHP persists postnatally, with potential molecular mechanisms revealed by Western-type diet challenge. METHODS IUGR juvenile baboons were fed a 7-week Western diet, with kidney biopsies, blood, and urine collected before and after challenge. Transcriptomics and metabolomics were used to analyze biosamples. RESULTS Pre-challenge IUGR kidney transcriptome and urine metabolome differed from controls. Post-challenge, sex and diet-specific responses in urine metabolite and renal signaling pathways were observed. Dysregulated mTOR signaling persisted postnatally in female pre-challenge. Post-challenge IUGR male response showed uncoordinated signaling suggesting proximal tubule injury. CONCLUSION Fetal undernutrition impacts juvenile offspring kidneys at the molecular level suggesting early-onset blood pressure dysregulation.
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Affiliation(s)
- Andrew C. Bishop
- Center for Precision MedicineDepartment of Internal Medicine, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kimberly D. Spradling‐Reeves
- Center for Precision MedicineDepartment of Internal Medicine, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Robert E. Shade
- Southwest National Primate Research CenterTexas Biomedical Research InstituteSan AntonioTexasUSA
| | - Kenneth J. Lange
- Department of Pharmaceuticals and BioengineeringSouthwest Research InstituteSan AntonioTexasUSA
| | - Shifra Birnbaum
- Southwest National Primate Research CenterTexas Biomedical Research InstituteSan AntonioTexasUSA
| | - Kristin Favela
- Department of Pharmaceuticals and BioengineeringSouthwest Research InstituteSan AntonioTexasUSA
| | - Edward J. Dick
- Southwest National Primate Research CenterTexas Biomedical Research InstituteSan AntonioTexasUSA
| | - Mark J. Nijland
- Department of Obstetrics and GynecologyUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Cun Li
- Department of Animal SciencesUniversity of WyomingLaramieWyomingUSA
| | - Peter W. Nathanielsz
- Southwest National Primate Research CenterTexas Biomedical Research InstituteSan AntonioTexasUSA
- Department of Animal SciencesUniversity of WyomingLaramieWyomingUSA
| | - Laura A. Cox
- Center for Precision MedicineDepartment of Internal Medicine, Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Southwest National Primate Research CenterTexas Biomedical Research InstituteSan AntonioTexasUSA
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Fonseca MJ, Santos AC, Barros H. Different levels of cardiometabolic indicators in multiple vs. singleton children. BMC Pediatr 2019; 19:331. [PMID: 31510947 PMCID: PMC6737661 DOI: 10.1186/s12887-019-1707-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 09/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to compare cardiometabolic indicators in singletons and multiples at age 7 and explore the birthweight mediation effect. METHODS We studied 5431 singletons and 103 sets of multiples from Generation XXI birth cohort. Anthropometric measurements, body composition, and fasting blood samples were obtained. Age- and sex-specific z-scores were calculated (additionally height-specific for blood pressure). Adjusted regression coefficients and respective 95% confidence intervals [β (95%CI)] were computed using path analysis. RESULTS Multiples had lower weight [- 0.419 (- 0.616;-0.223)], height [- 0.404 (- 0.594;-0.213)], BMI [- 0.470 (- 0.705;-0.234)], fat mass index [- 0.359 (- 0.565;-0.152)], waist circumference [- 0.342 (- 0.537;-0.147)], and waist-to-height ratio [- 0.165 (- 0.326;-0.003)] z-scores. These results were explained by the indirect effect via birthweight, which was also negative and significant for all the aforementioned cardiometabolic indicators, while no direct effect was present. There were also significant indirect effects regarding fat-free mass index, glucose, insulin, and blood pressure, though the total effects were not significant, due to the balance between direct and indirect effects. The only significant direct effect was regarding diastolic blood pressure [- 0.165 (- 0.302;-0.028)]. CONCLUSIONS At age 7, multiples presented better cardiometabolic indicators explained by lower weight at birth, except for the lower blood pressure which was independent of an effect via birthweight.
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Affiliation(s)
- Maria João Fonseca
- ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas n° 135, 4050-600, Porto, Portugal.
| | - Ana Cristina Santos
- ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas n° 135, 4050-600, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Henrique Barros
- ISPUP-EPIUnit, Universidade do Porto, Rua das Taipas n° 135, 4050-600, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Abstract
Chronic kidney disease affects more than 10% of the population. Programming studies have examined the interrelationship between environmental factors in early life and differences in morbidity and mortality between individuals. A number of important principles has been identified, namely permanent structural modifications of organs and cells, long-lasting adjustments of endocrine regulatory circuits, as well as altered gene transcription. Risk factors include intrauterine deficiencies by disturbed placental function or maternal malnutrition, prematurity, intrauterine and postnatal stress, intrauterine and postnatal overnutrition, as well as dietary dysbalances in postnatal life. This mini-review discusses critical developmental periods and long-term sequelae of renal programming in humans and presents studies examining the underlying mechanisms as well as interventional approaches to "re-program" renal susceptibility toward disease. Clinical manifestations of programmed kidney disease include arterial hypertension, proteinuria, aggravation of inflammatory glomerular disease, and loss of kidney function. Nephron number, regulation of the renin-angiotensin-aldosterone system, renal sodium transport, vasomotor and endothelial function, myogenic response, and tubuloglomerular feedback have been identified as being vulnerable to environmental factors. Oxidative stress levels, metabolic pathways, including insulin, leptin, steroids, and arachidonic acid, DNA methylation, and histone configuration may be significantly altered by adverse environmental conditions. Studies on re-programming interventions focused on dietary or anti-oxidative approaches so far. Further studies that broaden our understanding of renal programming mechanisms are needed to ultimately develop preventive strategies. Targeted re-programming interventions in animal models focusing on known mechanisms will contribute to new concepts which finally will have to be translated to human application. Early nutritional concepts with specific modifications in macro- or micronutrients are among the most promising approaches to improve future renal health.
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Affiliation(s)
- Eva Nüsken
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jörg Dötsch
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kai-Dietrich Nüsken
- Pediatric Nephrology, Department of Pediatrics, Medical Faculty, University of Cologne, Cologne, Germany
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Klatt N, Scherschel K, Schad C, Lau D, Reitmeier A, Kuklik P, Muellerleile K, Yamamura J, Zeller T, Steven D, Baldus S, Schäffer B, Jungen C, Eickholt C, Wassilew K, Schwedhelm E, Willems S, Meyer C. Development of nonfibrotic left ventricular hypertrophy in an ANG II-induced chronic ovine hypertension model. Physiol Rep 2017; 4:4/17/e12897. [PMID: 27613823 PMCID: PMC5027340 DOI: 10.14814/phy2.12897] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/19/2016] [Indexed: 12/29/2022] Open
Abstract
Hypertension is a major risk factor for many cardiovascular diseases and leads to subsequent concomitant pathologies such as left ventricular hypertrophy (LVH). Translational approaches using large animals get more important as they allow the use of standard clinical procedures in an experimental setting. Therefore, the aim of this study was to establish a minimally invasive ovine hypertension model using chronic angiotensin II (ANG II) treatment and to characterize its effects on cardiac remodeling after 8 weeks. Sheep were implanted with osmotic minipumps filled with either vehicle control (n = 7) or ANG II (n = 9) for 8 weeks. Mean arterial blood pressure in the ANG II‐treated group increased from 87.4 ± 5.3 to 111.8 ± 6.9 mmHg (P = 0.00013). Cardiovascular magnetic resonance imaging showed an increase in left ventricular mass from 112 ± 12.6 g to 131 ± 18.7 g after 7 weeks (P = 0.0017). This was confirmed by postmortem measurement of left ventricular wall thickness which was higher in ANG II‐treated animals compared to the control group (18 ± 4 mm vs. 13 ± 2 mm, respectively, P = 0.002). However, ANG II‐treated sheep did not reveal any signs of fibrosis or inflammatory infiltrates as defined by picrosirius red and H&E staining on myocardial full thickness paraffin sections of both atria and ventricles. Measurements of plasma high‐sensitivity C‐reactive protein and urinary 8‐iso‐prostaglandin F2α were inconspicuous in all animals. Furthermore, multielectrode surface mapping of the heart did not show any differences in epicardial conduction velocity and heterogeneity. These data demonstrate that chronic ANG II treatment using osmotic minipumps presents a reliable, minimally invasive approach to establish hypertension and nonfibrotic LVH in sheep.
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Affiliation(s)
- Niklas Klatt
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany
| | - Katharina Scherschel
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany
| | - Claudia Schad
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany
| | - Denise Lau
- DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Aline Reitmeier
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany
| | - Pawel Kuklik
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Zeller
- DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany Department of General and Interventional Cardiology, University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Steven
- Department of Cardiology and Cologne Cardiovascular Research Centre, Heart Centre University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology and Cologne Cardiovascular Research Centre, Heart Centre University of Cologne, Cologne, Germany
| | - Benjamin Schäffer
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Jungen
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany
| | - Christian Eickholt
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Wassilew
- German Heart Institute Berlin, Cardiovascular Pathology Unit, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany Department of Pathology, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Edzard Schwedhelm
- DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany Institute of Experimental and Clinical Pharmacology and Toxicology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany
| | - Christian Meyer
- Department of Cardiology-Electrophysiology, cNEP, cardiac Neuro- and Electrophysiology research group University Heart Centre University Hospital Hamburg-Eppendorf, Hamburg, Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Hamburg/Kiel/Lübeck, Germany
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Ovine fetal renal development impacted by multiple fetuses and uterine space restriction. J Dev Orig Health Dis 2014; 4:411-20. [PMID: 24159370 DOI: 10.1017/s2040174413000329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Intrauterine growth restriction (IUGR) from uteroplacental dysfunction causes impaired nephrogenesis and ultimately hypertension, but it is unknown whether IUGR caused by insufficient space for placental development seen in uterine anomalies and/or multifetal gestation exerts the same effects. Fetal renal development and metabolism were studied in an ovine space-restriction model by combining unilateral horn surgical ligation and/or multifetal gestation. Reduced placental attachment sites and placental weight per fetus defined space-restricted (USR) v. control nonrestricted (NSR) fetuses. Space-restricted fetuses exhibited evidence for decreased plasma volume, with higher hematocrit and plasma albumin at gestational day (GD) 120, followed by lower blood pO2, and higher osmolarity and creatinine at GD130, P < 0.05 for all. By combining treatments, fetal kidney weight relative to fetal weight was inversely related to both fetal weight and plasma creatinine levels, P < 0.05 for both. At GD130, space-restricted fetal kidney weights, cortical depths and glomerular generations were decreased, P < 0.05 for all. Space-restricted kidneys underwent an adaptive response by prolonging active nephrogenesis and increasing maculae densa number, P < 0.05 for both. The major renal adaptations in space-restricted IUGR fetuses included immaturity in both development and endocrine function, with evidence for impaired renal excretory function.
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Developmental origins of chronic renal disease: an integrative hypothesis. Int J Nephrol 2013; 2013:346067. [PMID: 24073334 PMCID: PMC3773449 DOI: 10.1155/2013/346067] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/17/2013] [Accepted: 07/03/2013] [Indexed: 01/06/2023] Open
Abstract
Cardiovascular diseases are one of the leading causes of mortality. Hypertension (HT) is one of the principal risk factors associated with death. Chronic kidney disease (CKD), which is probably underestimated, increases the risk and the severity of adverse cardiovascular events. It is now recognized that low birth weight is a risk factor for these diseases, and this relationship is amplified by a rapid catch-up growth or overfeeding during infancy or childhood. The pathophysiological and molecular mechanisms involved in the “early programming” of CKD are multiple and partially understood. It has been proposed that the developmental programming of arterial hypertension and chronic kidney disease is related to a reduced nephron endowment. However, this mechanism is still discussed. This review discusses the complex relationship between birth weight and nephron endowment and how early growth and nutrition influence long term HT and CKD. We hypothesize that fetal environment reduces moderately the nephron number which appears insufficient by itself to induce long term diseases. Reduced nephron number constitutes a “factor of vulnerability” when additional factors, in particular a rapid postnatal growth or overfeeding, promote the early onset of diseases through a complex combination of various pathophysiological pathways.
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Comparative proteomic analysis of kidney development-related proteins in the pig. In Vitro Cell Dev Biol Anim 2013; 49:315-23. [DOI: 10.1007/s11626-013-9602-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 03/13/2013] [Indexed: 01/22/2023]
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Faa G, Gerosa C, Fanni D, Monga G, Zaffanello M, Van Eyken P, Fanos V. Morphogenesis and molecular mechanisms involved in human kidney development. J Cell Physiol 2011; 227:1257-68. [DOI: 10.1002/jcp.22985] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Epidemiologic studies now strongly support the hypothesis, proposed over two decades ago, that developmental programming of the kidney impacts an individual's risk for hypertension and renal disease in later life. Low birth weight is the strongest current clinical surrogate marker for an adverse intrauterine environment and, based on animal and human studies, is associated with a low nephron number. Other clinical correlates of low nephron number include female gender, short adult stature, small kidney size, and prematurity. Low nephron number in Caucasian and Australian Aboriginal subjects has been shown to be associated with higher blood pressures, and, conversely, hypertension is less prevalent in individuals with higher nephron numbers. In addition to nephron number, other programmed factors associated with the increased risk of hypertension include salt sensitivity, altered expression of renal sodium transporters, altered vascular reactivity, and sympathetic nervous system overactivity. Glomerular volume is universally found to vary inversely with nephron number, suggesting a degree of compensatory hypertrophy and hyperfunction in the setting of a low nephron number. This adaptation may become overwhelmed in the setting of superimposed renal insults, e.g. diabetes mellitus or rapid catch-up growth, leading to the vicious cycle of on-going hyperfiltration, proteinuria, nephron loss and progressive renal functional decline. Many millions of babies are born with low birth weight every year, and hypertension and renal disease prevalences are increasing around the globe. At present, little can be done clinically to augment nephron number; therefore adequate prenatal care and careful postnatal nutrition are crucial to optimize an individual's nephron number during development and potentially to stem the tide of the growing cardiovascular and renal disease epidemics worldwide.
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Affiliation(s)
- Valerie A. Luyckx
- Associate Professor, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
- To whom correspondence should be addressed. E-mail:
| | - Khuloud Shukha
- Internal Medicine Resident, Mount Auburn Hospital, Cambridge, MA, USA; and
| | - Barry M. Brenner
- Samuel A. Levine Distinguished Professor of Medicine Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Simeoni U, Ligi I, Buffat C, Boubred F. Adverse consequences of accelerated neonatal growth: cardiovascular and renal issues. Pediatr Nephrol 2011; 26:493-508. [PMID: 20938692 DOI: 10.1007/s00467-010-1648-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 07/12/2010] [Accepted: 07/26/2010] [Indexed: 12/13/2022]
Abstract
Epidemiological and experimental studies show that the risk of cardiovascular and metabolic diseases at adulthood is inversely related to the weight at birth. Although with less evidence, low birth weight has been suggested to increase the risk of chronic kidney disease (CKD). It is well established that the developmental programming of arterial hypertension and of renal disease involves in particular renal factors, especially nephron endowment, which is reduced in low birth weight and maternal diabetes situations. Experimental studies, especially in rodents, have demonstrated the long-term influence of postnatal nutrition and/or postnatal growth on cardiovascular, metabolic and renal functions, while human data are scarce on this issue. Vascular and renal diseases appear to have a "multihits" origin, with reduced nephron number the initial hit and rapid postnatal growth the second hit. This review addresses the current understanding of the role of the kidney, both as a mechanism and as a target, in the developmental origins of adult disease theory, with a particular focus on the long-term effects of postnatal growth and nutrition.
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Affiliation(s)
- Umberto Simeoni
- Division of Neonatology, Hôpital la Conception, Assistance Publique-Hôpitaux de Marseille, 147 Boulevard Baille, 13385, Marseille, France.
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Benz K, Amann K. Maternal nutrition, low nephron number and arterial hypertension in later life. Biochim Biophys Acta Mol Basis Dis 2010; 1802:1309-17. [PMID: 20226855 DOI: 10.1016/j.bbadis.2010.03.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 12/30/2022]
Abstract
A potential role of the intrauterine environment in the development of low nephron number and hypertension in later life has been recently recognized in experimental studies and is also postulated in certain conditions in human beings. Nephrogenesis is influenced by genetic as well as by environmental and in particular maternal factors. In man nephrogenesis, i.e. the formation of nephrons during embryogenesis, takes place from weeks 5 to 36 of gestation with the most rapid phase of nephrogenesis occurring from the mid-2nd trimester until 36 weeks. This 16 week period is a very vulnerable phase where genetic and environmental factors such as maternal diet or medication could influence and disturb nephron formation leading to lower nephron number. Given a constant rise in body mass until adulthood lower nephron number may become "nephron underdosing" and result in maladaptive glomerular changes, i.e. glomerular hyperfiltration and glomerular enlargement. These maladaptive changes may then eventually lead to the development of glomerular and systemic hypertension and renal disease in later life. It is the purpose of this review to discuss the currently available experimental and clinical evidence for factors and mechanisms that could interfere with nephrogenesis with particular emphasis on maternal nutrition. In addition, we discuss the emerging concept of low nephron number being a new cardiovascular risk factor in particular for essential hypertension in later life.
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Affiliation(s)
- Kerstin Benz
- Department of Pediatric Nephrology, University of Erlangen-Nürnberg, Germany
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