Abstract-Hypertension (HTN) and chronic kidney disease are highly prevalent diseases that tend to occur more frequently among disadvantaged populations, in whom prenatal care also tends to be poor. More and more evidence is emerging highlighting the important role of fetal programming in the development of adult disease, suggesting a possible common pathophysiologic denominator in the development of these disorders. Epidemiologic evidence accumulated over the past 2 decades has demonstrated an association between low birth weight and subsequent adult HTN, diabetes, and cardiovascular disease. More recently, a similar association has been found with chronic kidney disease. Animal studies and indirect evidence from human studies support the hypothesis that low birth weight, as a marker of adverse intrauterine circumstances, is associated with a congenital deficit in nephron number. The precise mechanism of the reduction in nephron number has not been established, but several hypotheses have been put forward, including changes in DNA methylation, increased apoptosis in the developing kidney, alterations in renal renin-angiotensin system activity, and increased fetal glucocorticoid exposure. A reduction in nephron number is associated with compensatory glomerular hypertrophy and an increased susceptibility to renal disease progression. HTN in low birth weight individuals also appears to be mediated in part through a reduction in nephron number. Increased awareness of the implications of low birth weight and inadequate prenatal care should lead to public health policies that may have long-term benefits in curbing the epidemics of HTN, diabetes, and kidney disease in generations to come. Key Words: hypertension Ⅲ nephron number Ⅲ kidney H ypertension (HTN) is a prevalent disorder estimated to affect Ͼ25% of the world's adult population. 1 The incidence and prevalence of chronic kidney disease (CKD) is also on the rise with Ͼ20 million people being affected in the United States alone. Two of the major causes of CKD worldwide are HTN and diabetes mellitus (DM), particularly type 2 DM. Despite many years of concerted efforts, the etiology and molecular mechanisms underlying the development of these 2 common disorders, which, in most cases, result from a complex interplay between polygenic predisposition and environmental factors, remains unclear. The frequent concurrence of HTN, type 2 DM, insulin resistance, dyslipidemia, and CKD, all of which are also important cardiovascular risk factors, may reflect a common underlying mechanism. 2 One such mechanism that is becoming more and more recognized is the far reaching impact of the fetal environment.The process through which adverse effects of an environmental insult early in life, particularly in utero, can predispose to adult disease is known as fetal programming or developmental plasticity. Fetal programming refers to the observation that an adverse environmental stimulus experienced during a critical period of development in utero can induce long-term structural and fun...