Prematurity, perinatal inflammatory stress, and the predisposition to develop chronic kidney disease beyond oligonephropathy

Abstract

Prematurity and perinatal stress, such as intrauterine growth restriction (IUGR) and chorioamnionitis, are pathological processes creating an impaired intrauterine environment. These intrauterine factors are associated with the development of proteinuria, hypertension, and chronic kidney disease (CKD) later in life. Initially, this was thought to be secondary to oligonephropathy, subsequent glomerular hypertrophy, and hyperfiltration, leading to glomerulosclerosis, a further decrease in nephron number, and finally CKD. Nowadays, there is increasing evidence that prematurity and perinatal stress affect not only nephron endowment but also the maturation of podocytes and vasculogenesis. IUGR is associated with podocyte damage and an aggravated course of nephrotic syndrome. Moreover, preterm birth and IUGR are known to cause upregulation of the postnatal reninangiotensin system, resulting in hypertension. Chorioamnionitis causes damage to the glomeruli, thereby predisposing to the development of glomerulosclerosis. This review aims to summarize current knowledge on the influence of prematurity, IUGR, and chorioamnionitis on the development of different glomerular structures. After summarizing human and experimental data on low nephron number in general, a specific focus on the current understanding of podocyte and glomerular capillary formation in relation to prematurity and different causes of perinatal stress is presented.

Association Analysis in Children Born from Normal and Complicated Pregnancies—Cardiovascular Disease Associated microRNAs and the Incidence of Prehypertension/Hypertension, Overweight/Obesity, Valve Problems and Heart Defects

“…Some children born from complicated pregnancies have already been suffering from severe diseases, such as asthma [31,32], pulmonary hypertension [33][34][35], diabetes mellitus [36], cardiorenal metabolic syndrome [37], chronic kidney diseases [38,39], cardiovascular diseases [40], ophthalmic disorders [41], neurodevelopmental and neuropsychiatric disorders [42][43][44][45][46][47][48][49][50][51], most likely as a result of abnormal fetal programming.…”

Risk stratification for children with a solitary functioning kidney

“…As a consequence, nephron formation may not be complete in infants born prematurely, and continued nephron development with signs of abnormal morphology has been found in preterm neonates [39]. The interindividual differences in kidney development that were observed in this study suggested that early (during active nephrogenesis) postnatal exposure to an inflammatory environment [40] or nephrotoxins may play an additional role. Despite the knowledge that nephrotoxic drugs such as gentamicin or indomethacin can have disrupting effects on kidney development, they are frequently used in neonatal intensive care units [41,42].…”

Creatinine Trends to Detect Ibuprofen-Related Maturational Adverse Drug Events in Neonatal Life: A Simulation Study for the ELBW Newborn

“…Extremely low birth weight (ELBW, ≤1,000 g) infants are born during active nephrogenesis, making their kidneys extremely vulnerable to damage by external factors such as exposure to nephrotoxic drugs or diseases such as neonatal sepsis. Although the development of nephrons will continue after preterm delivery, the final amount of nephrons will be less for infants who are born prematurely with an ELBW ( Faa et al, 2010 ; Abitbol et al, 2016 ; Hoogenboom et al, 2020 ).…”