Nephron Number, Hypertension, Renal Disease, and Renal Failure

Hoy, W. E.; Hughson, Michael D.; Bertram, John F.; Douglas-Denton, Rebecca Nicole; Amann, Kerstin

doi:10.1681/asn.2005020172

Cited by 284 publications

(244 citation statements)

References 80 publications

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“…For example, Australian Aboriginal children have, on average, lower birth weights and smaller kidneys than white children (18). This population has been shown to have kidneys with fewer nephrons and to more frequently develop hypertension, proteinuria, and chronic renal failure (18,19). Similarly, Zhang et al (10) have shown that a common variant of the RET gene is associated with reduced KS in newborns and in the number of glomeruli, as measured in autopsy specimens of children that died before the age of 3 months.…”

Section: Discussionmentioning

confidence: 99%

Serum Creatinine Levels Are Significantly Influenced by Renal Size in the Normal Pediatric Population

Zazzo¹,

Stringini²,

Matteucci³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Clinical and experimental data have shown that differences in nephron endowment result in differences in renal mass and predisposition to chronic renal failure, hypertension, and proteinuria. We hypothesized that a significant proportion of the variance in GFR, as estimated by serum creatinine, is attributable to differences in renal size in normal children.Design, setting, participants, & measurements A total of 1748 normal renal ultrasounds that were performed in children older than 6 months were reviewed. For each ultrasound, serum creatinine, serum blood urea nitrogen, and systolic and diastolic office BP were recorded. Renal size was evaluated as a function of renal length and thickness. All data were normalized for height, weight, age, and gender.Results When expressed as SD scores, a significant correlation was found between kidney size and serum creatinine (P Ͻ 0.0001) and between kidney size and serum blood urea nitrogen (P Ͻ 0.002). When dividing kidney size data per quintiles, a difference of 0.51 SD score in serum creatinine was observed between the lowest and highest quintile. No significant correlation was found with office BP measurements.Conclusions These data show that, even in the normal pediatric population, differences in renal function are significantly explained by differences in renal mass. Methodologic limitations of this study are likely to underestimate this relationship.

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Section: Discussionmentioning

confidence: 99%

Serum Creatinine Levels Are Significantly Influenced by Renal Size in the Normal Pediatric Population

Zazzo¹,

Stringini²,

Matteucci³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…This could explain associations of low BW with such clinical outcomes as albuminuria, low-normal kidney function, and ESRD. [6][7][8][9][10][11][12][13][14][15][16][17]37 However, these are only a few studies, sometimes with a weak design, and the effects found were not strong. Case-control studies showed an OR of 1.5 for ESRD in subjects with BWs less than 2,500 g, but data for BW were missing in half the cases.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] The clinical consequences of these alterations were investigated at different levels, and associations were found of IUGR with microalbuminuria, 11,12 faster progression of renal dysfunction in patients with specific kidney diseases, 13,14 and end-stage renal disease (ESRD). 15,16 Because IUGR also was associated with other diseases, such as type 2 diabetes mellitus, it is difficult to disentangle direct from indirect effects of IUGR on advanced renal failure.…”

Section: Introductionmentioning

confidence: 99%

Effect of Intrauterine Growth Restriction on Kidney Function at Young Adult Age: The Nord Trøndelag Health (HUNT 2) Study

Hallan

Euser

Irgens

et al. 2008

American Journal of Kidney Diseases

127

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“…12 Nephrologist Barry Brenner first applied Barker' s theory to the development of CKD. Building on the observation that human nephron number is widely variable (ranging from 200 000 to 2 million per kidney 13 ), Brenner hypothesized that either a congenital or acquired reduction in nephron number could explain why some individuals are more susceptible to hypertension and CKD. 14 Brenner proposed that persons with a decreased complement of nephrons can initially maintain a normal glomerular filtration rate (GFR) as individual nephrons enlarge to increase the total surface area available for renal work.…”

Section: Fetal Origins Of Adult Diseasementioning

confidence: 99%

Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease

2013

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Thanks to remarkable advances in neonatal intensive care, infants who once had little chance for survival can now enter adulthood. Yet the consequences of premature birth or low birth weight (LBW) on nephrogenesis, final nephron number, and long-term kidney function are unclear. This review focuses on the theory, experimental evidence, and observational data that suggest an increased risk of chronic kidney disease (CKD) for infants born prematurely. Many premature and LBW infants begin life with an incomplete complement of immature nephrons. They are then exposed to a variety of external stressors that can hinder ongoing kidney development or cause additional nephron loss such as hemodynamic alterations, nephrotoxic medications, infections, and suboptimal nutrition. Acute kidney injury, in particular, may be a significant risk factor for the development of CKD. According to Brenner' s hypothesis, patients with decreased nephron number develop hyperfiltration that results in sodium retention, hypertension, nephron loss, and CKD due to secondary focal segmental glomerulosclerosis. Because the risk of CKD in premature and LBW infants has not been accurately determined, there are no evidence-based recommendations for screening or management. Yet with the first generation of infants from the surfactant era only now reaching adulthood, it is possible that there is already an unrecognized epidemic of CKD. We suggest individualized, risk-based assessments of premature and LBW infants due to the increased risk of CKD and call for additional research into the long-term risk for CKD these infants face.

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Nephron Number, Hypertension, Renal Disease, and Renal Failure

Cited by 284 publications

References 80 publications

Serum Creatinine Levels Are Significantly Influenced by Renal Size in the Normal Pediatric Population

Serum Creatinine Levels Are Significantly Influenced by Renal Size in the Normal Pediatric Population

Effect of Intrauterine Growth Restriction on Kidney Function at Young Adult Age: The Nord Trøndelag Health (HUNT 2) Study

Short-Term Gestation, Long-Term Risk: Prematurity and Chronic Kidney Disease

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