BackgroundDuring normal human kidney development, nephrogenesis (the formation of nephrons) is complete by term birth, with the majority of nephrons formed late in gestation. The aim of this study was to morphologically examine nephrogenesis in fetal human kidneys from 20 to 41 weeks of gestation.MethodsKidney samples were obtained at autopsy from 71 infants that died acutely in utero or within 24 h after birth. Using image analysis, nephrogenic zone width, the number of glomerular generations, renal corpuscle cross-sectional area and the cellular composition of glomeruli were examined. Kidneys from female and male infants were analysed separately.FindingsThe number of glomerular generations formed within the fetal kidneys was directly proportional to gestational age, body weight and kidney weight, with variability between individuals in the ultimate number of generations (8 to 12) and in the timing of the cessation of nephrogenesis (still ongoing at 37 weeks gestation in one infant). There was a slight but significant (r2 = 0.30, P = 0.001) increase in renal corpuscle cross-sectional area from mid gestation to term in females, but this was not evident in males. The proportions of podocytes, endothelial and non-epithelial cells within mature glomeruli were stable throughout gestation.InterpretationThese findings highlight spatial and temporal variability in nephrogenesis in the developing human kidney, whereas the relative cellular composition of glomeruli does not appear to be influenced by gestational age.

Objectives Preterm birth is linked to the development of hypertension later in life. This may relate to impaired glomerular capillary growth following preterm birth. The aim of this study was to determine the effects of preterm birth, and/or ventilation, on glomerular capillary growth in the neonatal lamb kidney. Methods Four experimental groups were analysed: 1) Preterm lambs delivered at 130d gestation (term=147d) and mechanically ventilated for 3 days (Preterm ventilated: n=9); 2) 133d gestational controls (Gestational control: n=5); 3) Term controls, unassisted breathing for 3 days (Term control: n=8); and 4) Term lambs ventilated for 3 days (Term ventilated: n=5). In perfusion-fixed kidneys, total nephron number and average total capillary length and surface area per renal corpuscle were stereologically assessed and total renal filtration surface area (TRFSA) calculated. Results In comparison to term controls, preterm lambs had significantly reduced glomerular capillary length, surface area and TRFSA, indicative of a low renal functional capacity. Term ventilated lambs exhibited significantly reduced glomerular capillary length and surface area compared to term controls, indicating that ventilation impairs glomerular capillary growth independently of preterm birth. Conclusion Impaired glomerular capillary growth and subsequent reduced TRFSA following preterm birth may mediate the increased predisposition to hypertension later in life.

A reduced nephron endowment early in life adversely impacts on long-term functional reserve in the kidney. A recent study has shown that acute exposure to chorioamnionitis during late gestation can adversely impact on nephrogenesis. The present study aimed to examine the effects of chronic, low-dose endotoxin exposure in utero, during the period of nephrogenesis, on nephron number and glomerular size in preterm lambs. Ewes were administered either endotoxin (lipopolysaccharide; 1 mg/day) or saline at 110-133 days of gestation (term approximately 147 days) via surgically implanted osmotic minipumps within the amniotic cavity. The ewes were induced to deliver preterm at 133 days gestation and the kidneys of the lambs were analysed at 8 weeks after term-equivalent age. Nephron number per kidney was determined using a combined optical disector and fractionator stereological approach; renal corpuscle size was also measured stereologically. At 8 weeks after term-equivalent age there was no significant effect of in utero exposure to endotoxin on bodyweight or kidney weight and there were no significant differences in nephron number, nephron density or renal corpuscle volume between groups. We conclude that chronic intrauterine inflammation during the period of nephrogenesis may not adversely impact on the number of nephrons formed within the kidney or on the volume of the renal corpuscle.

Serum cholinesterase concentrations were measured in 181 patients in chronic renal failure. Significant differences in cholinesterase concentrations were not found in patients undergoing dialysis and changes appear to be independent of the method of treatment used. Clinical experience with suxamethonium to facilitate tracheal intubation was satisfactory in 80 patients undergoing renal transplant. Apnoea occurred in one patient who was found subsequently to have atypical cholinesterase inheritance.

Aims The worldwide prevalence of gestational diabetes mellitus (GDM) is increasing. Studies in rodent models indicate that hyperglycaemia during pregnancy alters kidney development, yet few studies have examined if this is so in humans. The objective of this study was to evaluate the association of treated GDM with foetal kidney size. Materials and Methods Participants were recruited from an Australian tertiary hospital, and clinical data were collected from women without GDM and women diagnosed and treated for GDM and their offspring. Participants underwent an obstetric ultrasound at 32‐34 weeks gestation for foetal biometry and foetal kidney volume measurement. Results Sixty‐four non‐GDM and 64 GDM women participated in the study. Thirty percent of GDM women were diagnosed with fasting hyperglycaemia, while 89% had an elevated 2‐hour glucose level. Maternal age, weight and body mass index were similar in women with and without GDM. Estimated foetal weight, foetal kidney dimensions, total foetal kidney volume and birth weight were similar in offspring of women with and without GDM. Conclusions We conclude that a period of mild hyperglycaemia prior to diagnosis of GDM and treatment initiation, which coincides with a period of rapid nephron formation and kidney growth, does not alter kidney size at 32‐34 weeks gestation.

Preterm birth (defined as birth prior to 37 completed weeks of gestation), occurs in approximately 10% of all births and is one of the leading causes of neonatal morbidity and mortality worldwide. Preterm infants are born at a time when kidney development is still ongoing, and consequently can lead to renal impairment (in both the short-term and long-term), as well as severe glomerular abnormalities in some preterm infants. Since the glomerular abnormalities are not present in all preterm kidneys, this suggests that it is not preterm birth per se that leads to the glomerular abnormalities but may relate to factors associated with the etiology of the premature delivery, or factors in neonatal care. In this review, we provide an overview of what is currently known of how prenatal and postnatal factors can potentially impact on the immature kidneys of infants born preterm.

Background: Cluain Mhuire is a secondary adult mental health service based in Ireland. The COVID-19 pandemic resulted in many services moving online, including our coping with depression group. A shortened, online version of the face-to-face group was piloted; however, analysis showed that it was not as effective as the longer face-to-face group. Thus, a 12-session, 2.5-hour online group CBT (gCBT) was subsequently run to directly compare the online therapy with the original face-to-face group. Aims: The primary objective of the study is to evaluate the effectiveness of a 12-week gCBT programme adapted to videoconferencing in reducing self-reported symptoms of depression and anxiety and enhancing quality of life (QoL). Results will be compared with the same group programme delivered face-to-face. Method: This is a between-groups, naturalistic treatment outcome study. Pre and post measures include the Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and the World Health Organisation Quality of Life Scale (WHOQoL-Bref). A mixed between-within subjects analysis of variance was performed to assess the impact of the three interventions (face-to-face, 8-session online and 12-session online) on participant scores; 112 participants (65 women, 47 men) were recruited (mean age=41.85, SD=13.08). Results: All three interventions significantly improved depression, anxiety and QoL scores. There was no significant difference between the treatment groups. Attendance was highest in the 12-session online group, followed by the 8-session online group and 12-session in-person group. Conclusions: These results add to the growing evidence supporting the effectiveness of internet-delivered gCBT in reducing depressive symptoms.