Journal
PEDIATRIC NEPHROLOGY
Volume 27, Issue 10, Pages 1881-1887Publisher
SPRINGER
DOI: 10.1007/s00467-012-2169-x
Keywords
Kidney development; Glomerular hyperfiltration; Nephron endowment; Solitary functioning kidney; Intrauterine growth restriction; Prematurity
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Funding
- Dutch Kidney Foundation [KJPB.08.06]
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A low nephron number is, according to Brenner's hyperfiltration hypothesis, associated with hypertension, glomerular damage and proteinuria, and starts a vicious cycle that ends in renal failure over the long term. Nephron endowment is set during foetal life, and there is no formation of nephrons after 34-36 weeks of gestation, indicating that many factors before that time-point may have an impact on kidney development and reduce nephron numbers. Such factors include maternal malnutrition, stress, diseases, such as diabetes, uteroplacental insufficiency, maternal and neonatal drugs and premature birth. However, other congenital anomalies, such as renal hypoplasia, unilateral renal agenesis or multicystic dysplastic kidney, may also lead to a reduced nephron endowment, with an increased risk for hypertension, renal dysfunction and the need for renal replacement therapy. This review focusses on the causes and consequences of a low nephron endowment and will illustrate why there is safety in glomerular numbers. aEuro cent.
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