The Clinical Importance of Nephron Mass

Luyckx, Valérie A.; Brenner, Barry M.

doi:10.1681/asn.2009121248

Cited by 277 publications

(262 citation statements)

References 184 publications

Supporting

Mentioning

250

Contrasting

Unclassified

Order By: Relevance

“…Indeed, total filtration surface area is relatively preserved in kidneys with low nephron number, possibly at the expense of increased glomerular pressure, which can accelerate further nephron loss 14 . Consistent with this, increased glomerular size is a predictor of poorer renal outcomes among African Americans, Pima Indians and Aboriginal Australians, and in the absence of other causes, should be considered a surrogate for low nephron number 9 . Given the heterogeneity and hypertrophy occurring in glomeruli, kidney size has not been consistently found to correlate with nephron number in adults, but the relationship appears linear in infants under 3 months of age 18,52 Clinical impact of nephron mass…”

Section: Clinical Surrogates For Nephron Numbermentioning

confidence: 66%

“…This hypothesis suggested a plausible link between higher prevalences of hypertension and renal disease in populations with a higher incidence of low birth weight (LBW), where LBW was expected to be associated with lower nephron number (Figure 1) 8 . Consistent with this hypothesis, various animal models have confirmed the association of LBW with later-life hypertension, mediated, in part, by a reduced nephron number acquired in utero (the pathophysiologic mechanisms impacting nephrogenesis are reviewed elsewhere) 9 . Similarly, in humans, LBW is a risk factor for hypertension and CKD as will be discussed below 10 .…”

Section: Impact Of Fetal Development On Kidney Function and Outcomesmentioning

confidence: 73%

“…Prenatal factors: Maternal diets deficient in protein, total calories or iron have all been shown to reduce nephron numbers in experimental animals, most often associated with LBW 9 . In humans, maternal protein and micronutrient deficiencies are common in developing countries, and maternal malnutrition, underweight, iron deficiency and anemia are all recognized risk factors for LBW 35 .…”

Section: Developmental Determinants Of Low Nephron Numbermentioning

confidence: 99%

See 2 more Smart Citations

Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease

et al. 2013

View full text Add to dashboard Cite

Developmental programming of non-communicable diseases is now an established paradigm. With respect to hypertension and chronic kidney disease, adverse events experienced in utero can affect development of the fetal kidney and reduce final nephron number. Low birth weight and prematurity are the most consistent clinical surrogates for a low nephron number, and are associated with increased risk of hypertension, proteinuria and kidney disease in later life. Rapid weight gain in childhood or adolescence further compounds these risks. Low birth weight, prematurity and rapid childhood weight gain should alert clinicians to an individual's life-long risk of hypertension and kidney disease, prompting education to minimize additional risk factors and ensuring follow-up. Birth weight and prematurity are significantly impacted by maternal nutrition and health during pregnancy. Optimization of maternal health and early childhood nutrition could therefore attenuate this programming cycle and reduce the global burden of hypertension and kidney disease in the future.

show abstract

Section: Clinical Surrogates For Nephron Numbermentioning

confidence: 66%

Section: Impact Of Fetal Development On Kidney Function and Outcomesmentioning

confidence: 73%

Section: Developmental Determinants Of Low Nephron Numbermentioning

confidence: 99%

See 1 more Smart Citation

Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease

et al. 2013

View full text Add to dashboard Cite

show abstract

“…There is substantial variation in nephron endowment across the population (22). A low nephron endowment is associated with larger glomeruli, low birth weight (23,24), and increased risk of kidney failure (25,26). Prior studies suggest a high rate of CKD linked to low nephron endowment and glomerulomegaly, particularly in certain racial or ethnic groups (27)(28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Nephron Hypertrophy and Glomerulosclerosis and Their Association with Kidney Function and Risk Factors among Living Kidney Donors

Elsherbiny

Alexander²,

Kremers³

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives The relationship of kidney function and CKD risk factors to structural changes in the renal parenchyma of normal adults is unclear. This study assessed whether nephron hypertrophy and nephrosclerosis had similar or different associations with kidney function and risk factors.Design, setting, participants, & measurements From 1999 to 2009, 1395 living kidney donors had a core needle biopsy of their donated kidney during transplant surgery. The mean nonsclerotic glomerular volume and glomerular density (globally sclerotic and nonsclerotic) were estimated using the Weibel and Gomez stereologic methods. All tubules were counted in 1 cm 2 of cortex to determine a mean profile tubular area. Nephron hypertrophy was identified by larger glomerular volume, larger profile tubular area, and lower nonsclerotic glomerular density. Nephrosclerosis was identified by higher globally sclerotic glomerular density.Results The mean (6SD) age was 44612 years, 24-hour urine albumin excretion was 567 mg, measured GFR was 103617 ml/min per 1.73 m 2 , uric acid was 5.261.4 mg/dl, and body mass index was 2865 kg/m 2 . Of the study participants, 43% were men, 11% had hypertension, and 52% had a family history of ESRD. Larger glomerular volume, larger profile tubular area, and lower nonsclerotic glomerular density were correlated. Male sex, higher 24-hour urine albumin excretion, family history of ESRD, and higher body mass index were independently associated with each of these measures of nephron hypertrophy. Higher uric acid, higher GFR, and older age were also independently associated with some of these measures of nephron hypertrophy. Hypertension was not independently associated with measures of nephron hypertrophy. However, hypertension and older age were independently associated with higher globally sclerotic glomerular density.Conclusions Nephron hypertrophy and nephrosclerosis are structural characteristics in normal adults that relate differently to clinical characteristics and may reflect kidney function and risk factors via separate but inter-related pathways.

show abstract

“…That implicates that no drug, as far as we are aware, has been proven to be definitively safe to use during kidney development. As the long-term effects of low nephron endowment become more and more clear (51), it is highly important to study the effect of drugs on renal development. There are many modifying effects of environmental insults, such as prematurity and intrauterine growth restriction (5,51); therefore, combinations of several drugs and/or factors to study the interactions should also be included in future research.…”

Section: Perspectivesmentioning

confidence: 99%

Effect of Drugs on Renal Development

Schreuder¹,

Bueters²,

Huigen³

et al. 2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryMany nephrotoxic effects of drugs have been described, whereas the effect on renal development has received less attention. Nephrogenesis ceases at approximately 36 weeks of gestation, indicating that drugs administered to pregnant women and to preterm-born neonates may influence kidney development. Such an effect on renal development may lead to a wide spectrum of renal malformations (congenital anomalies of the kidney and urinary tract [CAKUT]), ranging from renal agenesis to a reduced nephron number. Any of these anomalies may have long-term sequelae, and CAKUT is the primary cause for renal replacement therapy in childhood. This review focuses on research into the effect of drug treatment during active nephrogenesis during pregnancy and in preterm-born infants. Because the effects of many widely used drugs have not been unraveled thus far, more research is needed to study the effect on renal development and long-term renal sequelae after drug treatment during nephrogenesis.

show abstract

The Clinical Importance of Nephron Mass

Cited by 277 publications

References 184 publications

Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease

Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease

Nephron Hypertrophy and Glomerulosclerosis and Their Association with Kidney Function and Risk Factors among Living Kidney Donors

Effect of Drugs on Renal Development

Contact Info

Product

Resources

About