The fetal environment: a critical phase that determines future renal outcomes in autosomal dominant polycystic kidney disease

• Type of Material: Article
• Authors: Arlene B Chapman, Emory University
• Language: English
• Date: 2012-05-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 International Society of Nephrology. Published by Elsevier Inc.
• Final Published Version (URL): http://dx.doi.org/10.1038/ki.2012.8
• Title of Journal or Parent Work: Kidney International
• ISSN: 0085-2538
• Volume: 81
• Issue: 9
• Start Page: 814
• End Page: 815
• Grant/Funding Information: The work of the author is supported by the CRISP cooperative agreement from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases (DK056956; CRISP ClinicalTrials.gov Identifier NCT 01039987), by a National Center for Research Resources Clinical and Translational Science Award (RR025008).
• Keywords: Urology & Nephrology; Science & Technology; VOLUME PROGRESSION; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Obstetrics and Gynecology; Health Sciences, General

Abstract

Orskov and colleagues demonstrate the impact of birth weight on the mean age of end-stage renal disease (ESRD) in a large Danish ADPKD cohort. Each kilogram of birth weight extended the mean age of ESRD onset by 1.7 years. Placental insufficiency, activation of the renin-angiotensin-aldosterone system, increased fetal vasopressin levels, compensatory increases in insulin like growth factor-I, and a reduction in total nephron number may all contribute to this observation. Collectively, these changes result in an accelerated pace of cyst formation and expansion, and an inability to maintain glomerular hyperfiltration during kidney expansion which results in a more rapid progression to ESRD. Therefore the intrauterine environment may play a critical role in disease severity in ADPKD.