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

Lancet. 2013 Jul 20;382(9888):273-83. doi: 10.1016/S0140-6736(13)60311-6. Epub 2013 May 31.


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 birthweight 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 birthweight, prematurity, and rapid childhood weight gain should alert clinicians to an individual's lifelong risk of hypertension and kidney disease, prompting education to minimise additional risk factors and ensuring follow-up. Birthweight and prematurity are affected substantially by maternal nutrition and health during pregnancy. Optimisation 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.

Publication types

  • Review

MeSH terms

  • Adult
  • Birth Weight / physiology
  • Blood Pressure / physiology
  • Body Mass Index
  • Child
  • Child Development / physiology
  • Child Welfare*
  • Female
  • Fetal Development / physiology
  • Glomerular Filtration Rate / physiology
  • Humans
  • Hypertension / embryology*
  • Hypertension / genetics
  • Infant, Low Birth Weight
  • Infant, Newborn
  • Infant, Premature
  • Kidney / embryology*
  • Kidney / growth & development
  • Maternal Nutritional Physiological Phenomena / physiology
  • Maternal Welfare
  • Nephrons / pathology
  • Pregnancy
  • Pregnancy Complications
  • Proteinuria / etiology
  • Renal Insufficiency, Chronic / embryology*
  • Renal Insufficiency, Chronic / genetics
  • Renal Insufficiency, Chronic / pathology
  • Risk Factors
  • Weight Gain / physiology