Prenatal Origins of Chronic Kidney Disease

Adverse exposures during fetal life and early childhood create increased vulnerability to development of later life chronic diseases, including CKD and its major precursors - hypertension, diabetes mellitus, central obesity, and atherosclerotic CVD. These exposures can modify both organ structure and epigenetic regulation of gene expression to yield an altered postnatal phenotype. This cluster of increasingly prevalent chronic diseases, including CKD, has common etiologic roots in abnormal fetal growth and development. Harmful early-life exposures include Maternal/Fetal Undernutrition (MFUN), Maternal/Fetal Energy Excess (MFEE), and sustained Psychosocial Stress (MFPS) during pregnancy. These conclusions are drawn from an integration of human and animal-based studies, together with established nephrologic literature addressing renal responses to nephron loss and renal injury patterns following the CKD precursors.