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Akalay S, Rayyan M, Fidlers T, van den Heuvel L, Levtchenko E, Arcolino FO. Impact of preterm birth on kidney health and development. Front Med (Lausanne) 2024; 11:1363097. [PMID: 38601116 PMCID: PMC11004308 DOI: 10.3389/fmed.2024.1363097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Preterm birth, defined as birth before the gestational age of 37 weeks, affects 11% of the newborns worldwide. While extensive research has focused on the immediate complications associated with prematurity, emerging evidence suggests a link between prematurity and the development of kidney disease later in life. It has been demonstrated that the normal course of kidney development is interrupted in infants born prematurely, causing an overall decrease in functional nephrons. Yet, the pathogenesis leading to the alterations in kidney development and the subsequent pathophysiological consequences causing kidney disease on the long-term are incompletely understood. In the present review, we discuss the current knowledge on nephrogenesis and how this process is affected in prematurity. We further discuss the epidemiological evidence and experimental data demonstrating the increased risk of kidney disease in these individuals and highlight important knowledge gaps. Importantly, understanding the intricate interplay between prematurity, abnormal kidney development, and the long-term risk of kidney disease is crucial for implementing effective preventive and therapeutic strategies.
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Affiliation(s)
- Sara Akalay
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Nephrology, Dialysis and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Maissa Rayyan
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Tom Fidlers
- Department of Gynecologic Oncology, Oscar Lambret Cancer Center, Lille, France
| | - Lambertus van den Heuvel
- Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Elena Levtchenko
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fanny Oliveira Arcolino
- Department of Pediatric Nephrology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Emma Center for Personalized Medicine, Amsterdam University Medical Centers, Amsterdam, Netherlands
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2
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Hingorani S, Gibson KL, Xie Y, Wang Y, Eddy S, Hartman J, Sampson M, Cassol C, Thomas D, Gipson DS, Trachtman H, Srivastava T, Reidy K. The association of low birthweight and prematurity on outcomes in children and adults with nephrotic syndrome-a NEPTUNE cohort study. Pediatr Nephrol 2023; 38:3297-3308. [PMID: 37140708 PMCID: PMC11186376 DOI: 10.1007/s00467-023-05876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/22/2022] [Accepted: 12/22/2022] [Indexed: 05/05/2023]
Abstract
BACKGROUND In single-center studies, both preterm birth and low birth weight (LBW) are associated with worse outcomes in childhood nephrotic syndrome. Using the Nephrotic Syndrome Study Network (NEPTUNE) observational cohort, we tested the hypothesis that in patients with nephrotic syndrome, hypertension, proteinuria status, and disease progression would be more prevalent and more severe in subjects with LBW and prematurity singly or in combination (LBW/prematurity). METHODS Three hundred fifty-nine adults and children with focal segmental glomerulosclerosis (FSGS) or minimal change disease (MCD) and available birth history were included. Estimated glomerular filtration rate (eGFR) decline and remission status were primary outcomes, and secondary outcomes were kidney histopathology, kidney gene expression, and urinary biomarkers. Logistic regression was used to identify associations with LBW/prematurity and these outcomes. RESULTS We did not find an association between LBW/prematurity and remission of proteinuria. However, LBW/prematurity was associated with greater decline in eGFR. This decline in eGFR was partially explained by the association of LBW/prematurity with APOL1 high-risk alleles, but the association remained after adjustment. There were no differences in kidney histopathology or gene expression in the LBW/prematurity group compared to normal birth weight/term birth. CONCLUSION LBW and premature babies who develop nephrotic syndrome have a more rapid decline in kidney function. We did not identify clinical or laboratory features that distinguished the groups. Additional studies in larger groups are needed to fully ascertain the effects of (LBW) and prematurity alone or in combination on kidney function in the setting of nephrotic syndrome.
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Affiliation(s)
- Sangeeta Hingorani
- University of Washington, Seattle Children's Hospital, Seattle, WA, USA.
| | | | - Yuping Xie
- Department of Pediatrics/Nephrology Bronx, Children's Hospital at Montefiore/Einstein, The Bronx, NY, USA
| | - Yujie Wang
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Sean Eddy
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - John Hartman
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew Sampson
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Broad Institute, Cambridge, MA, USA
| | | | | | - Debbie S Gipson
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Howard Trachtman
- Department of Pediatrics, Division of Nephrology, University of Michigan, Ann Arbor, MI, USA
| | - Tarak Srivastava
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kimberly Reidy
- Department of Pediatrics/Nephrology Bronx, Children's Hospital at Montefiore/Einstein, The Bronx, NY, USA
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3
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Sutherland MR, Black MJ. The impact of intrauterine growth restriction and prematurity on nephron endowment. Nat Rev Nephrol 2023; 19:218-228. [PMID: 36646887 DOI: 10.1038/s41581-022-00668-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2022] [Indexed: 01/18/2023]
Abstract
In humans born at term, maximal nephron number is reached by the time nephrogenesis is completed - at approximately 36 weeks' gestation. The number of nephrons does not increase further and subsequently remains stable until loss occurs through ageing or disease. Nephron endowment is key to the functional capacity of the kidney and its resilience to disease; hence, any processes that impair kidney development in the developing fetus can have lifelong adverse consequences for renal health and, consequently, for quality and length of life. The timing of nephrogenesis underlies the vulnerability of developing human kidneys to adverse early life exposures. Indeed, exposure of the developing fetus to a suboptimal intrauterine environment during gestation - resulting in intrauterine growth restriction (IUGR) - and/or preterm birth can impede kidney development and lead to reduced nephron endowment. Furthermore, emerging research suggests that IUGR and/or preterm birth is associated with an elevated risk of chronic kidney disease in later life. The available data highlight the important role of early life development in the aetiology of kidney disease and emphasize the need to develop strategies to optimize nephron endowment in IUGR and preterm infants.
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Affiliation(s)
- Megan R Sutherland
- Department of Anatomy and Developmental Biology and Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia
| | - Mary Jane Black
- Department of Anatomy and Developmental Biology and Monash Biomedicine Discovery Institute, Monash University, Clayton, VIC, Australia.
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4
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Good PI, Li L, Hurst HA, Serrano Herrera I, Xu K, Rao M, Bateman DA, Al-Awqati Q, D’Agati VD, Costantini F, Lin F. Low nephron endowment increases susceptibility to renal stress and chronic kidney disease. JCI Insight 2023; 8:e161316. [PMID: 36626229 PMCID: PMC9977438 DOI: 10.1172/jci.insight.161316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Preterm birth results in low nephron endowment and increased risk of acute kidney injury (AKI) and chronic kidney disease (CKD). To understand the pathogenesis of AKI and CKD in preterm humans, we generated potentially novel mouse models with a 30%-70% reduction in nephron number by inhibiting or deleting Ret tyrosine kinase in the developing ureteric bud. These mice developed glomerular and tubular hypertrophy, followed by the transition to CKD, recapitulating the renal pathological changes seen in humans born preterm. We injected neonatal mice with gentamicin, a ubiquitous nephrotoxic exposure in preterm infants, and detected more severe proximal tubular injury in mice with low nephron number compared with controls with normal nephron number. Mice with low nephron number had reduced proliferative repair with more rapid development of CKD. Furthermore, mice had more profound inflammation with highly elevated levels of MCP-1 and CXCL10, produced in part by damaged proximal tubules. Our study directly links low nephron endowment with postnatal renal hypertrophy, which in this model is maladaptive and results in CKD. Underdeveloped kidneys are more susceptible to gentamicin-induced AKI, suggesting that AKI in the setting of low nephron number is more severe and further increases the risk of CKD in this vulnerable population.
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Affiliation(s)
| | - Ling Li
- Department of Pediatrics and
| | | | | | - Katherine Xu
- Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons New York, New York, USA
| | - Meenakshi Rao
- Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston Massachusetts, USA
| | | | - Qais Al-Awqati
- Department of Internal Medicine, Columbia University Vagelos College of Physicians and Surgeons New York, New York, USA
| | - Vivette D. D’Agati
- Department of Pathology and Cellular Biology at Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Frank Costantini
- Department of Genetics and Development at Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Haruhara K, Kanzaki G, Sasaki T, Hatanaka S, Okabayashi Y, Puelles VG, Harper IS, Shimizu A, Cullen-McEwen LA, Tsuboi N, Yokoo T, Bertram JF. Associations between nephron number and podometrics in human kidneys. Kidney Int 2022; 102:1127-1135. [PMID: 36175177 DOI: 10.1016/j.kint.2022.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 12/14/2022]
Abstract
Podocyte loss and resultant nephron loss are common processes in the development of glomerulosclerosis and chronic kidney disease. While the cortical distribution of glomerulosclerosis is known to be non-uniform, the relationship between the numbers of non-sclerotic glomeruli (NSG), podometrics and zonal differences in podometrics remain incompletely understood. To help define this, we studied autopsy kidneys from 50 adults with median age 68 years and median eGFR 73.5 mL/min/1.73m2 without apparent glomerular disease in a cross-sectional analysis. The number of NSG per kidney was estimated using the physical dissector/fractionator combination, while podometrics were estimated using model-based stereology. The number of NSG per kidney was directly correlated with podocyte number per tuft and podocyte density. Each additional 100,000 NSG per kidney was associated with 26 more podocytes per glomerulus and 16 podocytes per 106 μm3 increase in podocyte density. These associations were independent of clinical factors and cortical zone. While podocyte number per glomerulus was similar in the three zones, superficial glomeruli were the smallest and had the highest podocyte density but smallest podocytes. Increasing age and hypertension were associated with lower podocyte number, with age mostly affecting superficial glomeruli, and hypertension mostly affecting juxtamedullary glomeruli. Thus, in this first study to report a direct correlation between the number of NSG and podometrics, we suggest that podocyte number is decreasing in NSG of individuals losing nephrons. However, another possible interpretation may be that more nephrons might protect against further podocyte loss.
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Affiliation(s)
- Kotaro Haruhara
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takaya Sasaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Saeko Hatanaka
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Okabayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan; III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor G Puelles
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia; III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ian S Harper
- Monash Micro Imaging, Monash University, Clayton, Australia
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Luise A Cullen-McEwen
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - John F Bertram
- Department of Anatomy and Developmental Biology, Monash Biomedicine Discovery Institute, Monash University, Melbourne, Australia; Australian Research Council (ARC) Training Centre for Cell and Tissue Engineering Technologies, Melbourne, Australia.
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Iyengar A, Bonilla-Félix M. Effects of Prematurity and Growth Restriction on Adult Blood Pressure and Kidney Volume. Adv Chronic Kidney Dis 2022; 29:243-250. [PMID: 36084971 DOI: 10.1053/j.ackd.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 11/11/2022]
Abstract
Gaining insight into the complex cycle of renal programming and its early-life clinical associations is essential to understand the origins of kidney disease. Prematurity and intrauterine growth restriction are associated with low nephron endowment. This increases the risk of developing hypertension and chronic kidney disease later in life. There is appreciable evidence to support mechanistic links between low nephron endowment secondary to intrauterine events and kidney size, kidney function, and blood pressure in postnatal life. A clear understanding of the cycle of developmental programming and consequences of fetal insults on the kidney is critical. In addition, the impact of events in the early postnatal period (accelerated postnatal growth, development of obesity, exposure to nephrotoxins) on the cardiovascular system and blood pressure of individuals born prematurely or with low birth weight is discussed. In summary, this review draws attention to the concepts of renal programming and nephron endowment and underscores the associations between intrauterine growth restriction, prematurity, and its clinical consequences in adult life.
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Affiliation(s)
- Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
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7
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The Usefulness of Urinary Periostin, Cytokeratin-18, and Endoglin for Diagnosing Renal Fibrosis in Children with Congenital Obstructive Nephropathy. J Clin Med 2021; 10:jcm10214899. [PMID: 34768419 PMCID: PMC8585114 DOI: 10.3390/jcm10214899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 12/28/2022] Open
Abstract
Congenital obstructive nephropathy (CON) leads to renal fibrosis and chronic kidney disease. The aim of the study was to investigate the predictive value of urinary endoglin, periostin, cytokeratin-18, and transforming growth factor-β1 (TGF-β1) for assessing the severity of renal fibrosis in 81 children with CON and 60 controls. Children were divided into three subgroups: severe, moderate scars, and borderline lesions based on 99mTc-ethylenedicysteine scintigraphy results. Periostin, periostin/Cr, and cytokeratin-18 levels were significantly higher in the study group compared to the controls. Children with severe scars had significantly higher urinary periostin/Cr levels than those with borderline lesions. In multivariate analysis, only periostin and cytokeratin-18 were independently related to the presence of severe and moderate scars, and periostin was independently related to borderline lesions. However, periostin did not differentiate advanced scars from borderline lesions. In ROC analysis, periostin and periostin/Cr demonstrated better diagnostic profiles for detection of advanced scars than TGF-β1 and cytokeratin-18 (AUC 0.849; 0.810 vs. 0.630; 0.611, respectively) and periostin for detecting borderline lesions than endoglin and periostin/Cr (AUC 0.777 vs. 0.661; 0.658, respectively). In conclusion, periostin seems to be a promising, non-invasive marker for assessing renal fibrosis in children with CON. CK-18 and TGF-β1 demonstrated low utility, and endoglin was not useful for diagnosing advanced scars.
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8
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Assessment of nephron number and single-nephron glomerular filtration rate in a clinical setting. Hypertens Res 2021; 44:605-617. [PMID: 33526913 DOI: 10.1038/s41440-020-00612-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 12/02/2020] [Accepted: 12/08/2020] [Indexed: 01/31/2023]
Abstract
Total nephron counts vary widely between individuals and may affect susceptibility to certain diseases, including hypertension and chronic kidney disease. Detailed analyses of whole kidneys collected from autopsy patients remain the only method for accurately counting nephrons in humans, with no equivalent option in living subjects. Current technological advances have enabled estimations of nephron numbers in vivo, particularly the use of total nephron number and whole-kidney glomerular filtration rate to estimate the mean single-nephron glomerular filtration rate. The use of this method would allow physicians to detect dynamic changes in filtration function at the single-nephron level rather than to simply count the number of nephrons that appear to be functioning. Currently available methods for estimating total nephron number in clinical practice have the potential to overcome limitations associated with autopsy analyses and may therefore pave the way for new therapeutic interventions and improved clinical outcomes.
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9
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Charlton JR, Baldelomar EJ, Hyatt DM, Bennett KM. Nephron number and its determinants: a 2020 update. Pediatr Nephrol 2021; 36:797-807. [PMID: 32350665 PMCID: PMC7606355 DOI: 10.1007/s00467-020-04534-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 12/30/2022]
Abstract
Studies of human nephron number have been conducted for well over a century and have uncovered a large variability in nephron number. However, the mechanisms influencing nephron endowment and loss, along with the etiology for the wide range among individuals are largely unknown. Advances in imaging technology have allowed investigators to revisit the principles of renal structure and physiology and their roles in the progression of kidney disease. Here, we will review the latest data on the influences impacting nephron number, innovations made over the last 6 years to understand and integrate renal structure and function, and new developments in the tools used to count nephrons in vivo.
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Affiliation(s)
- Jennifer R. Charlton
- University of Virginia School of Medicine, Department of Pediatrics, Division of Nephrology, Charlottesville, VA, USA
| | - Edwin J. Baldelomar
- Washington University in St. Louis, Department of Radiology, St. Louis, MO, USA
| | - Dylan M. Hyatt
- University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Kevin M. Bennett
- Washington University in St. Louis, Department of Radiology, St. Louis, MO, USA
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10
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Bennett KM, Baldelomar EJ, Morozov D, Chevalier RL, Charlton JR. New imaging tools to measure nephron number in vivo: opportunities for developmental nephrology. J Dev Orig Health Dis 2021; 12:179-183. [PMID: 31983353 PMCID: PMC8765346 DOI: 10.1017/s204017442000001x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The mammalian kidney is a complex organ, requiring the concerted function of up to millions of nephrons. The number of nephrons is constant after nephrogenesis during development, and nephron loss over a life span can lead to susceptibility to acute or chronic kidney disease. New technologies are under development to count individual nephrons in the kidney in vivo. This review outlines these technologies and highlights their relevance to studies of human renal development and disease.
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Affiliation(s)
- K M Bennett
- Department of Radiology, Washington University, Saint Louis, MO, USA
| | - E J Baldelomar
- Department of Radiology, Washington University, Saint Louis, MO, USA
| | - D Morozov
- Department of Radiology, Washington University, Saint Louis, MO, USA
| | - R L Chevalier
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - J R Charlton
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
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Abate KH, Abdulahi M, Abdulhay F, Arage G, Mecha M, Yenuss M, Hassen H, Belachew T. Consequences of exposure to prenatal famine on estimated glomerular filtration rate and risk of chronic kidney disease among survivors of the great Ethiopian famine (1983-85): a historical cohort study. Nutr J 2021; 20:19. [PMID: 33653353 PMCID: PMC7927414 DOI: 10.1186/s12937-021-00675-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The impact of an adverse prenatal environment such as famine exposure on the development of adulthood non-communicable chronic illnesses, including diabetes and hypertension has been well articulated in the recent past and supported by evidence. However, there exist few longitudinal studies conducted on the long term consequences of prenatal famine exposure on adulthood kidney function. Hence, we set out to examine whether prenatal exposure to the Ethiopian Great Famine (1983-1985) was associated with changes in estimated glomerular filtration rate (eGFR) and the risk of developing chronic kidney disease (CKD) later in adult life. METHODS The study was conducted in 219 famine exposed and 222 non exposed cohorts in Raya Kobo district, North Wollo Zone, Northern Ethiopia. Estimated GFR was computed from standardized serum creatinine using the CKD Epidemiology Collaboration (CKD-EPI) equation. The definition of CKD includes those with an eGFR of less than 60 ml/min/1.73 m2 on at least in two occasions of 90 days apart (with or without markers of kidney damage). Linear and logistic regression analyses were employed to examine the independent effect of prenatal famine exposure on eGFR and CKD respectively. RESULTS The mean (SD) serum creatinine of exposed and non-exposed groups were 0.78 (0.2) and 0.75 (0.2) respectively. The mean (SD) eGFR of exposed groups was 107.95 (27.49) while the non-exposed 114.48 (24.81) ml/min. In linear regression, the unadjusted model to examine the association between famine exposure and eGFR resulted in a significant negative beta coefficient (β = - 0.124: 95% CI: - 11.43, - 1.64). Adjusting the exposure for outstanding covariates of kidney health, including systolic blood pressure, fasting blood sugar and blood glucose did not alter the inverse relationship (β = -.114 95% CI: - 10.84, - 1.17). In the unadjusted bivariate logistic regression model, famine exposure resulted in nearly 2.7 times higher odds of developing CKD (OR: 2.68, 95% CI: 1.16, 6.2). The odds remained equivalent after adjusting for systolic blood pressure, fasting blood glucose and body mass index (OR = 2.61: 95% CI: 1.120, 6.09). CONCLUSION In the study setting, prenatal exposure to the Great Ethiopian Famine was associated with decreased eGFR and higher risk of developing CKD among survivors. These findings may imply that famine in early life may play a significant role in the development of kidney dysfunction in adulthood.
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Affiliation(s)
- Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Misra Abdulahi
- Department of Population and Family Heath, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Fedlu Abdulhay
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Getachew Arage
- Department of Nutrition and Dietetics, College of Health Sciences, DebreTabor University, Debre Tabor, Ethiopia
| | - Mohammed Mecha
- Department of Internal Medicine, Faculty of Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Mohammed Yenuss
- Department of Environmental Health Science, College of Health and Medical Sciences, Wollo University, Dessie, Ethiopia
| | - Habtamu Hassen
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
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12
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DeFreitas MJ, Katsoufis CP, Infante JC, Granda ML, Abitbol CL, Fornoni A. The old becomes new: advances in imaging techniques to assess nephron mass in children. Pediatr Nephrol 2021; 36:517-525. [PMID: 31953750 DOI: 10.1007/s00467-020-04477-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/09/2019] [Accepted: 01/08/2020] [Indexed: 12/19/2022]
Abstract
Renal imaging is widely used in the assessment of surrogate markers of nephron mass correlated to renal function. Autopsy studies have tested the validity of various imaging modalities in accurately estimating "true" nephron mass. However, in vivo assessment of nephron mass has been largely limited to kidney volume determination by ultrasonography (US) in pediatric populations. Practical limitations and risks create challenges in incorporating more precise 3D volumetric imaging, like magnetic resonance imaging (MRI), and computed tomography (CT) technologies, compared to US for routine kidney volume assessment in children. Additionally, accounting for structural anomalies such as hydronephrosis when estimating renal parenchymal area in congenital anomalies of the kidney and urinary tract (CAKUT) is important, as it correlates with chronic kidney disease (CKD) progression. 3D imaging using CT and MRI has been shown to be superior to US, which has traditionally relied on 2D measurements to estimate kidney volume using the ellipsoid calculation. Recent innovations using 3D and contrast-enhanced US (CEUS) provide improved accuracy with low risk. Indexing kidney volume to body surface area in children is an important standard that may allow early detection of CKD progression in high-risk populations. This review highlights current understanding of various imaging modalities in assessing nephron mass, discusses applications and limitations, and describes recent advances in the field of imaging and kidney disease. Although renal imaging has been a long-standing, essential tool in assessing kidney disease, innovation and new applications of established technologies provide important tools in the study and management of kidney disease in children.
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Affiliation(s)
- Marissa J DeFreitas
- Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA.
| | - Chryso P Katsoufis
- Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA
| | - Juan C Infante
- Section of Pediatric Radiology, Department of Diagnostic Radiology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael L Granda
- Division of General Internal Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carolyn L Abitbol
- Division of Pediatric Nephrology, University of Miami Miller School of Medicine, P.O. Box 016960 (M714), Miami, FL, 33130, USA
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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13
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Charlton JR, Xu Y, Wu T, deRonde KA, Hughes JL, Dutta S, Oxley GT, Cwiek A, Cathro HP, Charlton NP, Conaway MR, Baldelomar EJ, Parvin N, Bennett KM. Magnetic resonance imaging accurately tracks kidney pathology and heterogeneity in the transition from acute kidney injury to chronic kidney disease. Kidney Int 2020; 99:173-185. [PMID: 32916180 DOI: 10.1016/j.kint.2020.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/07/2020] [Accepted: 08/20/2020] [Indexed: 01/09/2023]
Abstract
Acute kidney injury (AKI) increases the risk for chronic kidney disease (CKD). However, there are few tools to detect microstructural changes after AKI. Here, cationic ferritin-enhanced magnetic resonance imaging (CFE-MRI) was applied to examine the heterogeneity of kidney pathology in the transition from AKI to CKD. Adult male mice received folic acid followed by cationic ferritin and were euthanized at four days (AKI), four weeks (CKD-4) or 12 weeks (CKD-12). Kidneys were examined by histologic methods and CFE-MRI. In the CKD-4 and CKD-12 groups, glomerular number was reduced and atubular cortical lesions were observed. Apparent glomerular volume was larger in the AKI, CKD-4 and CKD-12 groups compared to controls. Glomerular hypertrophy occurred with ageing. Interglomerular distance and glomerular density were combined with other MRI metrics to distinguish the AKI and CKD groups from controls. Despite significant heterogeneity, the noninvasive (MRI-based) metrics were as accurate as invasive (histological) metrics at distinguishing AKI and CKD from controls. To assess the toxicity of cationic ferritin in a CKD model, CKD-4 mice received cationic ferritin and were examined one week later. The CKD-4 groups with and without cationic ferritin were similar, except the iron content of the kidney, liver, and spleen was greater in the CKD-4 plus cationic ferritin group. Thus, our study demonstrates the accuracy and safety of CFE-MRI to detect whole kidney pathology allowing for the development of novel biomarkers of kidney disease and providing a foundation for future in vivo longitudinal studies in mouse models of AKI and CKD to track nephron fate.
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Affiliation(s)
- Jennifer R Charlton
- Department of Pediatrics, Division Nephrology, University of Virginia, Charlottesville, Virginia, USA.
| | - Yanzhe Xu
- ASU-Mayo Center for Innovative Imaging, School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Teresa Wu
- ASU-Mayo Center for Innovative Imaging, School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Kim A deRonde
- Department of Pediatrics, Division Nephrology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Shourik Dutta
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Gavin T Oxley
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Helen P Cathro
- Department of Pathology University of Virginia, Charlottesville, Virginia, USA
| | - Nathan P Charlton
- Department of Toxicology, University of Virginia, Virginia, Charlottesville, USA
| | - Mark R Conaway
- Division of Translational Research and Applied Statistics Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Edwin J Baldelomar
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Neda Parvin
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kevin M Bennett
- Department of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
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14
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Bonsib SM. Renal Hypoplasia, From Grossly Insufficient to Not Quite Enough: Consideration for Expanded Concepts Based Upon the Author's Perspective With Historical Review. Adv Anat Pathol 2020; 27:311-330. [PMID: 32520748 PMCID: PMC7458098 DOI: 10.1097/pap.0000000000000269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hypoplasia is defined in the Merriman-Webster dictionary as "a condition of arrested development in which an organ, or part, remains below the normal size, or in an immature state." The degree of reduced size is not definitional. Renal hypoplasia, however, has historically been defined as a more marked reduction in renal mass such that presentation in childhood is the norm. There are 3 commonly recognized types of renal hypoplasia, simple hypoplasia, oligomeganephronic hypoplasia (oligomeganephronia) and segmental hypoplasia (Ask-Upmark kidney). They have in common a reduction in the number of renal lobes. A fourth type, not widely recognized, is cortical hypoplasia where nephrogenesis is normal but there is a reduction in the number of nephron generations. Recently there has been great interest in milder degrees of reduced nephron mass, known as oligonephronia because of its association with risk of adult-onset hypertension and chronic kidney disease. Since the last pathology review of this topic was published by Jay Bernstein in 1968, an update of the renal pathology findings in renal hypoplasia is provided with a review of 18 new cases. The renal hypoplasias are then framed within the modern concept of oligonephronia, its diverse causes and prognostic implications.
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15
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Kandasamy Y, Rudd D, Lumbers ER, Smith R. An evaluation of preterm kidney size and function over the first two years of life. Pediatr Nephrol 2020; 35:1477-1482. [PMID: 32297001 PMCID: PMC7316836 DOI: 10.1007/s00467-020-04554-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND We carried out a study to determine the impact of prematurity on kidney development in the first 2 years of life. METHODS In this prospective study, extremely preterm neonates (gestation < 28 weeks) were recruited and underwent assessments at 6, 12, and 24 months of age. A cohort of neonates born term were also recruited and followed up for 24 months. The primary outcomes measured in this study were total kidney volume (TKV) and estimated glomerular filtration rate (eGFR); albuminuria and blood pressure measurements (all provided as mean (standard deviation)) were the secondary outcomes. RESULTS Fifty-three premature and 31 term neonates (control) were recruited. At the age of 24 months (corrected age), infants born preterm had significantly smaller TKV (56.1 (9.4) vs. 64.8 (10.2) mL; P = 0.006). There was no difference in eGFR. These preterm infants were smaller (11.25 (1.53) vs. 12.9 (1.8) kg; P = 0.002) and shorter (83.8 (3.0) vs. 86.3 (3.4) cm; P = 0.02) when compared with the control group. At 6, 12, and 18 months respectively, preterm infants had, relative to their height, significantly smaller kidney volumes (0.54 (0.1) vs. 0.59 (0.1) mL/cm, P = 0.05; 0.61 (0.1) vs.0.71 (0.1) mL/cm, P = 0.003; and 0.67 (0.1) vs.0.76 (0.1) mL/cm, P = 0.006). CONCLUSIONS Relative to body length, TKV in premature infants is smaller. Since length reflects adult body proportions more accurately than BSA, TKV to height ratio may be a more important measure in the child. Despite smaller TKV (and therefore fewer nephrons), infants born prematurely achieve similar eGFRs in the first 24 months of life, probably due to single-nephron hyperfiltration.
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Affiliation(s)
- Yogavijayan Kandasamy
- Department of Neonatology, The Townsville Hospital, 100 Angus Smith Drive, Douglas, Queensland, 4814, Australia.
- Mothers and Babies Research Centre, Hunter Medical Research Institute, HMRI, The University of Newcastle, Newcastle, NSW, 2310, Australia.
- College of Medicine and Dentistry, James Cook University, Douglas, QLD, 4814, Australia.
| | - Donna Rudd
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Douglas, QLD, 4814, Australia
| | - Eugenie R Lumbers
- Mothers and Babies Research Centre, Hunter Medical Research Institute, HMRI, The University of Newcastle, Newcastle, NSW, 2310, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, 2310, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, HMRI, The University of Newcastle, Newcastle, NSW, 2310, Australia
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16
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Role of the renin-angiotensin system in kidney development and programming of adult blood pressure. Clin Sci (Lond) 2020; 134:641-656. [PMID: 32219345 DOI: 10.1042/cs20190765] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
Abstract
Adverse events during fetal life such as insufficient protein intake or elevated transfer of glucocorticoid to the fetus may impact cardiovascular and metabolic health later in adult life and are associated with increased incidence of type 2 diabetes, ischemic heart disease and hypertension. Several adverse factors converge and suppress the fetal renin-angiotensin-aldosterone system (RAAS). The aim of this review is to summarize data on the significance of RAAS for kidney development and adult hypertension. Genetic inactivation of RAAS in rodents at any step from angiotensinogen to angiotensin II (ANGII) type 1 receptor (AT1) receptors or pharmacologic inhibition leads to complex developmental injury to the kidneys that has also been observed in human case reports. Deletion of the 'protective' arm of RAAS, angiotensin converting enzyme (ACE) 2 (ACE-2) and G-protein coupled receptor for Angiotensin 1-7 (Mas) receptor does not reproduce the AT1 phenotype. The changes comprise fewer glomeruli, thinner cortex, dilated tubules, thicker arterioles and arteries, lack of vascular bundles, papillary atrophy, shorter capillary length and volume in cortex and medulla. Altered activity of systemic and local regulators of fetal-perinatal RAAS such as vitamin D and cyclooxygenase (COX)/prostaglandins are associated with similar injuries. ANGII-AT1 interaction drives podocyte and epithelial cell formation of vascular growth factors, notably vascular endothelial growth factor (VEGF) and angiopoietins (Angpts), which support late stages of glomerular and cortical capillary growth and medullary vascular bundle formation and patterning. RAAS-induced injury is associated with lower glomerular filtration rate (GFR), lower renal plasma flow, kidney fibrosis, up-regulation of sodium transporters, impaired sodium excretion and salt-sensitive hypertension. The renal component and salt sensitivity of programmed hypertension may impact dietary counseling and choice of pharmacological intervention to treat hypertension.
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17
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Lumbers ER, Kandasamy Y, Delforce SJ, Boyce AC, Gibson KJ, Pringle KG. Programming of Renal Development and Chronic Disease in Adult Life. Front Physiol 2020; 11:757. [PMID: 32765290 PMCID: PMC7378775 DOI: 10.3389/fphys.2020.00757] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/11/2020] [Indexed: 12/18/2022] Open
Abstract
Chronic kidney disease (CKD) can have an insidious onset because there is a gradual decline in nephron number throughout life. There may be no overt symptoms of renal dysfunction until about two thirds or more of the nephrons have been destroyed and glomerular filtration rate (GFR) falls to below 25% of normal (often in mid-late life) (Martinez-Maldonaldo et al., 1992). Once End Stage Renal Disease (ESRD) has been reached, survival depends on renal replacement therapy (RRT). CKD causes hypertension and cardiovascular disease; and hypertension causes CKD. Albuminuria is also a risk factor for cardiovascular disease. The age of onset of CKD is partly determined during fetal life. This review describes the mechanisms underlying the development of CKD in adult life that results from abnormal renal development caused by an adverse intrauterine environment. The basis of this form of CKD is thought to be mainly due to a reduction in the number of nephrons formed in utero which impacts on the age dependent decline in glomerular function. Factors that affect the risk of reduced nephron formation during intrauterine life are discussed and include maternal nutrition (malnutrition and obesity, micronutrients), smoking and alcohol, use of drugs that block the maternal renin-angiotensin system, glucocorticoid excess and maternal renal dysfunction and prematurity. Since CKD, hypertension and cardiovascular disease add to the disease burden in the community we recommend that kidney size at birth should be recorded using ultrasound and those individuals who are born premature or who have small kidneys at this time should be monitored regularly by determining GFR and albumin:creatinine clearance ratio. Furthermore, public health measures aimed at limiting the prevalence of obesity and diabetes mellitus as well as providing advice on limiting the amount of protein ingested during a single meal, because they are all associated with increased glomerular hyperfiltration and subsequent glomerulosclerosis would be beneficial.
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Affiliation(s)
- Eugenie R Lumbers
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Yoga Kandasamy
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia.,Department of Neonatology, Townsville University Hospital, Douglas, QLD, Australia
| | - Sarah J Delforce
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Amanda C Boyce
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Karen J Gibson
- School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Kirsty G Pringle
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, Newcastle, NSW, Australia
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18
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Abstract
PURPOSE OF REVIEW Many studies have suggested low nephron endowment at birth contributes to the risk of developing hypertension and chronic kidney disease (CKD) later in life. Loss of nephrons with age and disease is largely a subclinical process. New technologies are needed to count nephrons as glomerular filtration rate (GFR) is a poor surrogate for nephron number. RECENT FINDINGS Cortical volume, glomerular density, and percent globally sclerotic glomeruli are imperfect surrogates for nephron number. The disector-fractionator method is the most accurate method to count nephrons but is limited to autopsy settings. Glomerular density combined with kidney imaging and ultrafiltration coefficient-based methods require a kidney biopsy, and have been applied in living humans (kidney donors). Low nephron number predicts a higher postdonation urine albumin. Contrast-enhanced MRI has detected glomeruli without a biopsy, but so far, not in living humans. SUMMARY Currently, there is no accurate and well tolerated method for determining nephron number in living humans. A clinically useful method may allow GFR to be replaced by its more relevant determinants: nephron number and single nephron GFR. This could revolutionize nephrology by separating the measurement of chronic disease (nephron loss) from more reversible hemodynamic effects (nephron hyperfiltration/hypofiltration).
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19
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Kuure S, Sariola H. Mouse Models of Congenital Kidney Anomalies. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1236:109-136. [PMID: 32304071 DOI: 10.1007/978-981-15-2389-2_5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) are common birth defects, which cause the majority of chronic kidney diseases in children. CAKUT covers a wide range of malformations that derive from deficiencies in embryonic kidney and lower urinary tract development, including renal aplasia, hypodysplasia, hypoplasia, ectopia, and different forms of ureter abnormalities. The majority of the genetic causes of CAKUT remain unknown. Research on mutant mice has identified multiple genes that critically regulate renal differentiation. The data generated from this research have served as an excellent resource to identify the genetic bases of human kidney defects and have led to significantly improved diagnostics. Furthermore, genetic data from human CAKUT studies have also revealed novel genes regulating kidney differentiation.
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Affiliation(s)
- Satu Kuure
- GM-Unit, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland. .,Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland. .,Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Hannu Sariola
- Medicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Paediatric Pathology, HUSLAB, Helsinki University Central Hospital, Helsinki, Finland
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20
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Luyckx VA, Brenner BM. Clinical consequences of developmental programming of low nephron number. Anat Rec (Hoboken) 2019; 303:2613-2631. [PMID: 31587509 DOI: 10.1002/ar.24270] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/30/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
Nephron number in humans varies up to 13-fold, likely reflecting the impact of multiple factors on kidney development, including inherited body size and ethnicity, as well as maternal health and nutrition, fetal exposure to gestational diabetes or preeclampsia and other environmental factors, which may potentially be modifiable. Such conditions predispose to low or high offspring birth weight, growth restriction or preterm birth, which have all been associated with increased risks of higher blood pressures and/or kidney dysfunction in later life. Low birth weight, preterm birth, and intrauterine growth restriction are associated with reduced nephron numbers. Humans with hypertension and chronic kidney disease tend to have fewer nephrons than their counterparts with normal blood pressures or kidney function. A developmentally programmed reduction in nephron number therefore enhances an individual's susceptibility to hypertension and kidney disease in later life. A low nephron number at birth may not lead to kidney dysfunction alone except when severe, but in the face of superimposed acute or chronic kidney injury, a kidney endowed with fewer nephrons may be less able to adapt, and overt kidney disease may develop. Given that millions of babies are born either too small, too big or too soon each year, the population impact of altered renal programming is likely to be significant. Many gestational exposures are modifiable, therefore urgent attention is required to implement public health measures to optimize maternal, fetal, and child health, to prevent or mitigate the consequences of developmental programming, to improve the health future generations.
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Affiliation(s)
- Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Switzerland
| | - Barry M Brenner
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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21
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Hokke S, de Zoysa N, Carr BL, Abruzzo V, Coombs PR, Allan CA, East C, Ingelfinger JR, Puelles VG, Black MJ, Ryan D, Armitage JA, Wallace EM, Bertram JF, Cullen‐McEwen LA. Normal foetal kidney volume in offspring of women treated for gestational diabetes. Endocrinol Diabetes Metab 2019; 2:e00091. [PMID: 31592117 PMCID: PMC6775447 DOI: 10.1002/edm2.91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/02/2019] [Accepted: 08/12/2019] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Stacey Hokke
- Development and Stem Cells ProgramDepartment of Anatomy and Developmental BiologyBiomedicine Discovery InstituteMonash UniversityClaytonVic.Australia
| | - Natasha de Zoysa
- Development and Stem Cells ProgramDepartment of Anatomy and Developmental BiologyBiomedicine Discovery InstituteMonash UniversityClaytonVic.Australia
| | - Bethany L. Carr
- Monash Women's Maternity ServicesMonash HealthClaytonVic.Australia
| | - Veronica Abruzzo
- Monash Women's Maternity ServicesMonash HealthClaytonVic.Australia
| | - Peter R. Coombs
- Diagnostic ImagingMonash HealthClaytonVic.Australia
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVic.Australia
| | - Carolyn A. Allan
- Endocrine Services in PregnancyMonash HealthClaytonVic.Australia
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVic.Australia
- Hudson Institute of Medical ResearchClaytonVic.Australia
| | - Christine East
- Monash Women's Maternity ServicesMonash HealthClaytonVic.Australia
- School of Nursing and MidwiferyMonash UniversityClaytonVic.Australia
| | | | - Victor G. Puelles
- Development and Stem Cells ProgramDepartment of Anatomy and Developmental BiologyBiomedicine Discovery InstituteMonash UniversityClaytonVic.Australia
- Department of Nephrology and Clinical ImmunologyRWTH Aachen University ClinicAachenGermany
- Department of Medicine IIIUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Mary J. Black
- Development and Stem Cells ProgramDepartment of Anatomy and Developmental BiologyBiomedicine Discovery InstituteMonash UniversityClaytonVic.Australia
| | - Danica Ryan
- Development and Stem Cells ProgramDepartment of Anatomy and Developmental BiologyBiomedicine Discovery InstituteMonash UniversityClaytonVic.Australia
| | - James A. Armitage
- Development and Stem Cells ProgramDepartment of Anatomy and Developmental BiologyBiomedicine Discovery InstituteMonash UniversityClaytonVic.Australia
- School of Medicine (Optometry)Deakin UniversityWaurn PondsVic.Australia
| | - Euan M. Wallace
- Department of Obstetrics and GynaecologyMonash UniversityClaytonVic.Australia
- The Ritchie CentreMonash Institute of Medical ResearchMonash UniversityClaytonVic.Australia
| | - John F. Bertram
- Development and Stem Cells ProgramDepartment of Anatomy and Developmental BiologyBiomedicine Discovery InstituteMonash UniversityClaytonVic.Australia
| | - Luise A. Cullen‐McEwen
- Development and Stem Cells ProgramDepartment of Anatomy and Developmental BiologyBiomedicine Discovery InstituteMonash UniversityClaytonVic.Australia
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22
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Li J, Guandalini M, Mcinnes H, Kandasamy Y, Trnka P, Moritz K. The impact of prematurity on postnatal growth of different renal compartments. Nephrology (Carlton) 2019; 25:116-124. [DOI: 10.1111/nep.13623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Joan Li
- Faculty of MedicineUniversity of Queensland Brisbane Queensland Australia
| | - Michael Guandalini
- Medical Imaging and Nuclear MedicineQueensland Children's Hospital Brisbane Queensland Australia
| | - Helena Mcinnes
- Department of NeonatologyTownsville Hospital University of Newcastle Douglas Queensland Australia
| | - Yogavijayan Kandasamy
- Department of NeonatologyTownsville Hospital University of Newcastle Douglas Queensland Australia
| | - Peter Trnka
- Department of Nephrology, Queensland Children's Hospital, Brisbane and School of MedicineUniversity of Queensland Brisbane Queensland Australia
| | - Karen Moritz
- Centre for Children's Health Research, and School of Biomedical ScienceUniversity of Queensland Brisbane Queensland Australia
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23
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Fattah H, Layton A, Vallon V. How Do Kidneys Adapt to a Deficit or Loss in Nephron Number? Physiology (Bethesda) 2019; 34:189-197. [PMID: 30968755 DOI: 10.1152/physiol.00052.2018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A deficit or loss in the number of nephrons, the functional unit of the kidney, can induce compensatory growth and hyperfunction of remaining nephrons. An increase in single nephron glomerular filtration rate (SNGFR) aims to compensate but may be deleterious in the long term. The increase in SNGFR is determined by the dynamics of nephron loss, total remaining GFR, the body's excretory demand, and the functional capacity to sustain single nephron hyperfunction.
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Affiliation(s)
- Hadi Fattah
- Departments of Medicine and Pharmacology, Division of Nephrology and Hypertension, University of California San Diego , San Diego, California.,Department of Veterans Affairs, San Diego Healthcare System, San Diego, California
| | - Anita Layton
- Department of Applied Mathematics and School of Pharmacy, University of Waterloo , Waterloo, Ontario , Canada.,Departments of Mathematics, Biomedical Engineering, and Medicine, Duke University , Durham, North Carolina
| | - Volker Vallon
- Departments of Medicine and Pharmacology, Division of Nephrology and Hypertension, University of California San Diego , San Diego, California.,Department of Veterans Affairs, San Diego Healthcare System, San Diego, California
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24
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Development of the urogenital system is regulated via the 3'UTR of GDNF. Sci Rep 2019; 9:5302. [PMID: 30923332 PMCID: PMC6438985 DOI: 10.1038/s41598-019-40457-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/13/2019] [Indexed: 12/30/2022] Open
Abstract
Mechanisms controlling ureter lenght and the position of the kidney are poorly understood. Glial cell-line derived neurotrophic factor (GDNF) induced RET signaling is critical for ureteric bud outgrowth, but the function of endogenous GDNF in further renal differentiation and urogenital system development remains discursive. Here we analyzed mice where 3′ untranslated region (UTR) of GDNF is replaced with sequence less responsive to microRNA-mediated regulation, leading to increased GDNF expression specifically in cells naturally transcribing Gdnf. We demonstrate that increased Gdnf leads to short ureters in kidneys located in an abnormally caudal position thus resembling human pelvic kidneys. High GDNF levels expand collecting ductal progenitors at the expense of ureteric trunk elongation and result in expanded tip and short trunk phenotype due to changes in cell cycle length and progenitor motility. MEK-inhibition rescues these defects suggesting that MAPK-activity mediates GDNF’s effects on progenitors. Moreover, Gdnf hyper mice are infertile likely due to effects of excess GDNF on distal ureter remodeling. Our findings suggest that dysregulation of GDNF levels, for example via alterations in 3′UTR, may account for a subset of congenital anomalies of the kidney and urinary tract (CAKUT) and/or congenital infertility cases in humans and pave way to future studies.
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25
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Marzuillo P, Guarino S, Grandone A, Di Somma A, Diplomatico M, Rambaldi PF, Decimo F, Miraglia Del Giudice E, La Manna A, Polito C. Congenital solitary kidney size at birth could predict reduced eGFR levels later in life. J Perinatol 2019; 39:129-134. [PMID: 30341401 DOI: 10.1038/s41372-018-0260-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/01/2018] [Accepted: 10/08/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate the impact of congenital solitary functioning kidney (CSFK) length, measured early in life, on the eGFR levels during the follow-up. STUDY DESIGN We retrospectively selected 162 CSFK patients undergoing, within 60 days of life, renal length (RL) measurement by ultrasound. We divided the population in: Group 1 = RL ≥ 2 standard deviation score (SDS). Group 2 = RL < 2 SDS and showing RL ≥ 2 SDS during the follow-up. Group 3 = RL < 2 SDS and showing RL < 2 SDS during the follow-up. PRIMARY OUTCOME development of eGFR below the range of normality. RESULTS The median follow-up period of the overall population was 6.2 years (range 2-21.5 years). The cumulative proportion of patients free of primary outcome at 15 years of age was 96.4% in group 1, 64.6% in group 2, and 45.6% in group 3 (p = 0.03). The RL > 2 SDS within 60 days of life was a significant protective factor (hazard ratio = 0.13; 95% C.I. 0.02-0.97) against development of primary outcome. CONCLUSION RL ≥ 2 SDS within 60 days of life could identify a population of CSFK with reduced risk of presenting reduced eGFR levels later in life.
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Affiliation(s)
- Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy.
| | - Stefano Guarino
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Anna Grandone
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Allegra Di Somma
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Mario Diplomatico
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Pier Francesco Rambaldi
- Department of Radiological Sciences, Nuclear Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Decimo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Angela La Manna
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
| | - Cesare Polito
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Napoli, Italy
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Jain S, Chen F. Developmental pathology of congenital kidney and urinary tract anomalies. Clin Kidney J 2018; 12:382-399. [PMID: 31198539 PMCID: PMC6543978 DOI: 10.1093/ckj/sfy112] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Indexed: 12/18/2022] Open
Abstract
Congenital anomalies of the kidneys or lower urinary tract (CAKUT) are the most common causes of renal failure in children and account for 25% of end-stage renal disease in adults. The spectrum of anomalies includes renal agenesis; hypoplasia; dysplasia; supernumerary, ectopic or fused kidneys; duplication; ureteropelvic junction obstruction; primary megaureter or ureterovesical junction obstruction; vesicoureteral reflux; ureterocele; and posterior urethral valves. CAKUT originates from developmental defects and can occur in isolation or as part of other syndromes. In recent decades, along with better understanding of the pathological features of the human congenital urinary tract defects, researchers using animal models have provided valuable insights into the pathogenesis of these diseases. However, the genetic causes and etiology of many CAKUT cases remain unknown, presenting challenges in finding effective treatment. Here we provide an overview of the critical steps of normal development of the urinary system, followed by a description of the pathological features of major types of CAKUT with respect to developmental mechanisms of their etiology.
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Affiliation(s)
- Sanjay Jain
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Feng Chen
- Division of Nephrology, Department of Medicine, Washington University School of Medicine, St Louis, MO, USA
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27
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Kandasamy Y, Rudd D, Lumbers ER, Smith R. Female preterm indigenous Australian infants have lower renal volumes than males: A predisposing factor for end-stage renal disease? Nephrology (Carlton) 2018; 24:933-937. [PMID: 30350455 PMCID: PMC6790612 DOI: 10.1111/nep.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2018] [Indexed: 11/28/2022]
Abstract
Aim Indigenous Australians have an increased risk of developing chronic kidney disease (CKD). Indigenous women have a higher rate of CKD than men. In a cohort of Indigenous and non‐Indigenous preterm neonates, we assessed total renal volume (TRV) (a proxy indicator for nephron number). We hypothesized that there would be no difference in renal volume between these two groups at term corrected (37 weeks gestation). Methods Normally grown preterm neonates less than 32 weeks of gestation were recruited and at term corrected dates, the neonates underwent renal ultrasonography (TRV measurements), urine microalbumin‐creatinine ratio and serum analysis for Cystatin C measurement for estimated glomerular filtration rate (eGFR) calculation. Results One hundred and five neonates (38 Indigenous; 67 non‐Indigenous) were recruited. Indigenous neonates were significantly more premature and of lower birth weight. At term corrected age, Indigenous neonates had a significantly smaller TRV (18.5 (4.2) vs 21.4 (5.1) cm3; P = 0.027) despite no significant difference in body weight. Despite having a smaller TRV, there was no significant difference in eGFR between Indigenous and Non‐indigenous neonates (47.8 [43.2–50.4] vs 46.2 [42.6–53.3] ml/min per 1.73 m2; P = 0.986). These infants achieve similar eGFR through hyperfiltration, which likely increases their future risk of CKD. There was no difference in microalbumin‐creatinine ratio. Female Indigenous neonates, however, had significantly smaller TRV compared with Indigenous male neonates (15.9 (3.6) vs 20.6 (3.6) cm3; P = 0.006), despite no difference in eGFR, birth weight, gestational age, and weight at term corrected. Conclusion The difference in TRV is likely to be an important risk factor for the difference in morbidity and mortality from renal disease reported between male and female Indigenous adults. Indigenous Australians are known to have an increased risk of developing CKD. The authors examined total renal volume (TRV) in a cohort of Indigenous and non‐Indigenous preterm neonates, and found that female Indigenous neonates had significantly smaller TRV compared with Indigenous male neonates.
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Affiliation(s)
- Yogavijayan Kandasamy
- Department of Neonatology, The Townsville Hospital, Queensland, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, HMRI, The University of Newcastle, Newcastle, New South Wales, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Brisbane, Queensland, Australia
| | - Donna Rudd
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Brisbane, Queensland, Australia
| | - Eugenie R Lumbers
- Mothers and Babies Research Centre, Hunter Medical Research Institute, HMRI, The University of Newcastle, Newcastle, New South Wales, Australia.,School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, New South Wales, Australia
| | - Roger Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, HMRI, The University of Newcastle, Newcastle, New South Wales, Australia
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28
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Mathiesen JS, Godballe C, Brusgaard K. Letter to the Editor regarding the paper by N. Azzam et al. 'Germline polymorphisms on RET proto-oncogene involved in medullary thyroid carcinoma in a Druze family'. Eur J Cancer 2018; 93:154-155. [PMID: 29433789 DOI: 10.1016/j.ejca.2018.01.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 01/04/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Jes Sloth Mathiesen
- Department of ORL Head & Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, DK-5000 Odense, Denmark.
| | - Christian Godballe
- Department of ORL Head & Neck Surgery, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark.
| | - Klaus Brusgaard
- Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, DK-5000 Odense, Denmark; Department of Clinical Genetics, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark.
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29
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Wang N, Ning Z, Xia F, Chen C, Cheng J, Chen Y, Lu Y. Exposure to famine in early life and chronic kidney diseases in adulthood. Nutr Diabetes 2018; 8:4. [PMID: 29335447 PMCID: PMC5851427 DOI: 10.1038/s41387-017-0014-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/01/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022] Open
Abstract
Objective Chronic kidney disease (CKD) is an increasing contributor to the global disease burden. Previous findings indicated that exposure to famine in early life was associated with various metabolic diseases and urinary protein levels. We aimed to assess whether the exposure to China’s Great Famine 1959–1962 during fetal or childhood period was associated with glomerular filtration rate (GFR) and risk of CKD (eGFR<60 mL/min per 1.73 m2) in adulthood. Materials and methods SPECT-China was a population-based observational study in 2014–2015. Totally, 5124 women were included from SPECT-China study. Based on the birth year, they were divided into fetal-exposed (1959–1962), childhood-exposed (1949–1958), adolescence/young adult-exposed (1921–1948), and non-exposed (1963–1974, reference). The estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration equation. CKD was defined as eGFR less than 60 mL/min per 1.73 m2. Results Compared with the non-exposed, fetal exposure to famine was significantly associated with lower eGFR (B −1.47, 95%CI −2.81, −1.13) and greater risk of having CKD (OR 2.85, 95%CI 1.25, 6.50) in the crude model adjusting age. Further adjustments for demographic variables, body mass index, diabetes, and blood pressure did not qualitatively change the association (eGFR B −1.35, 95%CI −2.67, −0.04; CKD OR 2.42, 95%CI 1.05, 5.58). This association was not found in childhood-exposed and adolescence/young adult-exposed individuals. Conclusions Prenatal exposure to famine may have long-term effects on declined GFR and the development of CKD in humans. thus, fetal stage may be an important time window to prevent CKD in later life.
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Affiliation(s)
- Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhiyuan Ning
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jing Cheng
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | | | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
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30
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Diehm CJ, Lumbers ER, Weatherall L, Keogh L, Eades S, Brown A, Smith R, Johnson V, Pringle KG, Rae KM. Assessment of Fetal Kidney Growth and Birth Weight in an Indigenous Australian Cohort. Front Physiol 2018; 8:1129. [PMID: 29379446 PMCID: PMC5770802 DOI: 10.3389/fphys.2017.01129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/20/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction: Indigenous Australians experience higher rates of renal disease and hypertension than non-Indigenous Australians. Low birth weight is recognized as a contributing factor in chronic disease and has been shown to increase the risk of renal failure in adulthood. A smaller kidney volume with fewer nephrons places an individual at risk of hypertension and renal failure. Indigenous Australians have fewer nephrons than non-Indigenous Australians. In this study, intrauterine fetal and kidney growth were evaluated in 174 Indigenous Australian babies throughout gestation in order to record and evaluate fetal growth and kidney size, within a population that is at high risk for chronic illness. Methods: Pregnant women that identified as Indigenous, or non-Indigenous women that were pregnant with a partner who identified as an Indigenous Australian were eligible to participate. Maternal history, smoking status, blood and urine samples and fetal ultrasounds were collected throughout pregnancy. Fetal kidney measurements were collected using ultrasound. Statistical analysis was performed using the Stata 14.1 software package. Results: 15.2% of babies were born prematurely. 44% of the mothers reported smoking in pregnancy. The median birth weight of this cohort was 3,240 g. Male fetuses had higher kidney to body weight ratios than female fetuses (P = 0.02). The birth weights of term neonates whose mothers smoked during pregnancy were lower (327 g, P < 0.001) than the birth weights of term babies from non-smoking mothers. The kidney volumes of babies whose mothers smoked were also smaller (P = 0.02), but were in proportion to body weight. Conclusion: In this cohort of Indigenous women smoking was associated with both increased number of preterm births and with a reduction in birth weights, even of term infants. Since kidney volume is a surrogate measure of nephron number and nephrogenesis is complete at birth, babies whose mothers smoked during pregnancy must have fewer nephrons than those from non-smoking mothers. Previous studies have shown that glomerular filtration rate is not related to birth weight, thus infants with smaller kidney volumes are hyperfiltering from birth and therefore are likely to be more susceptible to early onset renal disease in later life.
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Affiliation(s)
- Christopher J Diehm
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia.,Department of Rural Health, University of Newcastle, Tamworth, NSW, Australia
| | - Eugenie R Lumbers
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia.,Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Loretta Weatherall
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Lyniece Keogh
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Sandra Eades
- Heart Failure Research Group, Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Alex Brown
- Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Roger Smith
- Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Vanessa Johnson
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Kirsty G Pringle
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia.,Faculty of Health and Medicine, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Kym M Rae
- Gomeroi Gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre for Reproductive Sciences, University of Newcastle, Newcastle, NSW, Australia.,Department of Rural Health, University of Newcastle, Tamworth, NSW, Australia
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Kandasamy Y, Rudd D, Smith R, Lumbers ER, Wright IMR. Extra uterine development of preterm kidneys. Pediatr Nephrol 2018; 33:1007-1012. [PMID: 29500630 PMCID: PMC5943378 DOI: 10.1007/s00467-018-3899-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/19/2018] [Accepted: 01/19/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We carried out a study to determine the impact of prematurity on renal development. The primary outcomes measured were nephrinuria and albuminuria; renal volume and glomerular filtration rate were the secondary outcomes. METHODS Preterm neonates born at less than 28 weeks of gestation, with birth weight between 10th and 90th centile (appropriate for gestational age), were recruited and underwent assessments at 28, 32 and 37 weeks postmenstrual age (PMA). RESULTS Fifty-three premature neonates and 31 term neonates (control) were recruited. The median gestational age of the premature neonates was 26.4 [24.7-27.4] weeks, with a mean birth weight of 886 (179) g. The mean gestational age of term neonates was 39.1 (1.2) weeks and the mean birth weight was 3406 (406) g. The median age of the term neonates was 6.5 [3.0-12.5] days. The total kidney volume (TKV) almost doubled from 10.3 (2.9) cm3 at 28 weeks PMA to 19.2 (3.7) cm3 at 37 weeks PMA (P = 0.0001). TKV at 37 weeks PMA was significantly smaller compared to term neonates (19.2 (3.7) vs 26.3 (7.0) cm3; P = 0.0001). However, there was no significant difference in estimated glomerular filtration rate (eGFR) between premature neonates (at 37 weeks PMA) and term neonates (control) (43.5 [39.7-48.9] vs. 42.0 [38.2-50.0] mL/min/1.73 m2; P = 0.75). There was a statistically significant decline in nephrin-creatinine ratio and albumin-creatinine ratio from 32 to 37 weeks PMA. CONCLUSIONS Despite having a smaller renal volume (and fewer nephrons), extremely premature neonates achieve similar eGFRs at corrected term as term-born neonates, likely through single nephron hyperfiltration. Extremely premature neonates also show evidence of glomerular injury.
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Affiliation(s)
- Yogavijayan Kandasamy
- Department of Neonatology, The Townsville Hospital, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia. .,Mothers and Babies Research Centre, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, 2308, Australia. .,College of Public Health, Medical and Veterinary Sciences, The James Cook University, Douglas, QLD, 4814, Australia.
| | - Donna Rudd
- 0000 0004 0474 1797grid.1011.1College of Public Health, Medical and Veterinary Sciences, The James Cook University, Douglas, QLD 4814 Australia
| | - Roger Smith
- 0000 0000 8831 109Xgrid.266842.cMothers and Babies Research Centre, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Eugenie R Lumbers
- 0000 0000 8831 109Xgrid.266842.cMothers and Babies Research Centre, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308 Australia ,0000 0000 8831 109Xgrid.266842.cSchool of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Ian MR Wright
- 0000 0000 8831 109Xgrid.266842.cMothers and Babies Research Centre, Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW 2308 Australia ,0000 0004 0486 528Xgrid.1007.6Illawarra Health and Medical Research Institute and Graduate Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW 2522 Australia
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Phelep A, Laouari D, Bharti K, Burtin M, Tammaccaro S, Garbay S, Nguyen C, Vasseur F, Blanc T, Berissi S, Langa-Vives F, Fischer E, Druilhe A, Arnheiter H, Friedlander G, Pontoglio M, Terzi F. MITF - A controls branching morphogenesis and nephron endowment. PLoS Genet 2017; 13:e1007093. [PMID: 29240767 PMCID: PMC5746285 DOI: 10.1371/journal.pgen.1007093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/28/2017] [Accepted: 11/01/2017] [Indexed: 12/31/2022] Open
Abstract
Congenital nephron number varies widely in the human population and individuals with low nephron number are at risk of developing hypertension and chronic kidney disease. The development of the kidney occurs via an orchestrated morphogenetic process where metanephric mesenchyme and ureteric bud reciprocally interact to induce nephron formation. The genetic networks that modulate the extent of this process and set the final nephron number are mostly unknown. Here, we identified a specific isoform of MITF (MITF-A), a bHLH-Zip transcription factor, as a novel regulator of the final nephron number. We showed that overexpression of MITF-A leads to a substantial increase of nephron number and bigger kidneys, whereas Mitfa deficiency results in reduced nephron number. Furthermore, we demonstrated that MITF-A triggers ureteric bud branching, a phenotype that is associated with increased ureteric bud cell proliferation. Molecular studies associated with an in silico analyses revealed that amongst the putative MITF-A targets, Ret was significantly modulated by MITF-A. Consistent with the key role of this network in kidney morphogenesis, Ret heterozygosis prevented the increase of nephron number in mice overexpressing MITF-A. Collectively, these results uncover a novel transcriptional network that controls branching morphogenesis during kidney development and identifies one of the first modifier genes of nephron endowment. The number of nephrons, the functional unit of kidney, varies widely among humans. Indeed, it has been shown that kidneys may contain from 0.3 to more than 2 million of nephrons. Nephrons are formed during development via a coordinated morphogenetic program in which the metanephric mesenchyme reciprocally and recursively interacts with the ureteric bud. The fine-tuning of this cross-talk determines the final number of nephrons. Strong evidence indicates that suboptimal nephron endowment is associated with an increased risk of hypertension and chronic kidney disease, a major healthcare burden. Indeed, chronic kidney disease is characterized by the progressive decline of renal function towards end stage renal disease, which occurs once a critical number of nephrons has been lost. Elucidating the molecular mechanisms that control nephron endowment is, therefore, a critical issue for public health. However, little is known about the factors that determine the final number of nephrons in the healthy population. Our data showed that nephron endowment is genetically predetermined and identified Mitfa, a bHLH transcription factor, as one of the first modifiers of nephron formation during kidney development. By generating an allelic series of transgenic mice expressing different levels of MITF-A, we discovered that MITF-A promotes final nephron endowment. In addition, we elucidated the molecular mechanisms by which MITF-A promotes nephron formation and identified RET as one of the critical effectors.
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Affiliation(s)
- Aurélie Phelep
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | - Denise Laouari
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | - Kapil Bharti
- Unit on Ocular and Stem Cells Translational Research National Eye Institute, National Institutes of Health, Bethesda, MD, United States of America
| | - Martine Burtin
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | - Salvina Tammaccaro
- INSERM U1016-CNRS UMR 8104, Université Paris Descartes, Institut Cochin, Paris, France
| | - Serge Garbay
- INSERM U1016-CNRS UMR 8104, Université Paris Descartes, Institut Cochin, Paris, France
| | - Clément Nguyen
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | - Florence Vasseur
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | - Thomas Blanc
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | - Sophie Berissi
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | | | - Evelyne Fischer
- INSERM U1016-CNRS UMR 8104, Université Paris Descartes, Institut Cochin, Paris, France
| | - Anne Druilhe
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | - Heinz Arnheiter
- Scientist Emeritus, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive, Bethesda, MD, United States of America
| | - Gerard Friedlander
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
| | - Marco Pontoglio
- INSERM U1016-CNRS UMR 8104, Université Paris Descartes, Institut Cochin, Paris, France
| | - Fabiola Terzi
- INSERM U1151-CNRS UMR 8253, Université Paris Descartes, Institut Necker Enfants Malades, Département « Croissance et Signalisation », Hôpital Necker Enfants Malades, Paris, France
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He C, Ma J, Jiang Y, Su X, Zhang X, Chen W, Ye Z, Deng T, Deng W, Yang A. Associations between RET tagSNPs and their haplotypes and susceptibility, clinical severity, and thyroid function in patients with differentiated thyroid cancer. PLoS One 2017; 12:e0187968. [PMID: 29131865 PMCID: PMC5683616 DOI: 10.1371/journal.pone.0187968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/30/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND It is unclear whether common genetic variants of the RET proto-oncogene contribute to disease susceptibility, clinical severity, and thyroid function in differentiated thyroid cancer (DTC). METHODS A total of 300 DTC patients and 252 healthy controls were enrolled in this study. Seven RET tagging single nucleotide polymorphisms were genotyped using the KASPar platform. RESULTS Subgroup analysis showed that concomitant thyroid benign diseases were less likely to occur in DTC subjects with the rs1799939 AG or AG plus AA genotypes (odds ratio (OR) = 1.93 and 1.88, P = 0.009 and 0.011, respectively). A rare haplotype, CGGATAA, was associated statistically with a reduced risk of DTC (OR = 0.18, P = 0.001). Concerning the aggressive features of DTC, higher level of N stage was more likely to occur in subjects carrying the wild-type genotypes at rs1800860 site (for dominant model: OR = 0.48, P = 0.008). Another rare haplotype, CAAGCGT, conferred increased risk for the occurrence of distant metastasis (OR = 7.57, P = 0.009). Notably, higher thyroid stimulating hormone levels and lower parathyroid hormone levels were found in patients with rs2075912, rs2565200, and rs2742240 heterozygotes and rare homozygotes; similar results were observed between PTH levels and rs1800858. CONCLUSION This study provided useful information on RET variants that should be subjected to further study.
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Affiliation(s)
- Caiyun He
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jiangjun Ma
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | | | - Xuan Su
- Department of Head and Neck, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Xiao Zhang
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Weichao Chen
- Department of Head and Neck, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zulu Ye
- Department of Molecular Diagnostics, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Tiancheng Deng
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenze Deng
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ankui Yang
- Department of Head and Neck, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- * E-mail:
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Kanzaki G, Puelles VG, Cullen-McEwen LA, Hoy WE, Okabayashi Y, Tsuboi N, Shimizu A, Denton KM, Hughson MD, Yokoo T, Bertram JF. New insights on glomerular hyperfiltration: a Japanese autopsy study. JCI Insight 2017; 2:94334. [PMID: 28978800 DOI: 10.1172/jci.insight.94334] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/24/2017] [Indexed: 12/15/2022] Open
Abstract
It has been suggested that low nephron number contributes to glomerular hypertension and hyperperfusion injury in progressive chronic kidney disease (CKD). The incidence of CKD in Japan is among the highest in the world, but the reasons remain unclear. We estimated total nephron (glomerular) number (NglomTOTAL) as well as numbers of nonsclerosed (NglomNSG) and globally sclerosed glomeruli (NglomGSG), and the mean volume of nonsclerosed glomeruli (VglomNSG) in Japanese normotensive, hypertensive, and CKD subjects and investigated associations between these parameters and estimated glomerular filtration rate (eGFR). Autopsy kidneys from age-matched Japanese men (9 normotensives, 9 hypertensives, 9 CKD) had nephron number and VglomNSG estimated using disector/fractionator stereology. Subject eGFR, single-nephron eGFR (SNeGFR), and the ratio SNeGFR/VglomNSG were calculated. NglomNSG in Japanese with hypertension (392,108 ± 87,605; P < 0.001) and CKD (268,043 ± 106,968; P < 0.001) was less than in normotensives (640,399 ± 160,016). eGFR was directly correlated with NglomNSG (r = 0.70, P < 0.001) and inversely correlated with VglomNSG (r = -0.53, P < 0.01). SNeGFR was higher in hypertensives than normotensives (P = 0.03), but was similar in normotensives and CKD, while the ratio SNeGFR/VglomNSG was similar in normotensives and hypertensives but markedly reduced in CKD. Nephron number in Japanese with hypertension or CKD was low. This results in a higher SNeGFR in hypertensives compared with normotensive and CKD subjects, but lowered SNeGFR/VglomNSG in CKD subjects, suggesting that changes in GFR are accommodated by glomerular hypertrophy rather than glomerular hypertension. These findings suggest glomerular hypertrophy is a dominant factor in maintenance of GFR under conditions of low nephron number.
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Affiliation(s)
- Go Kanzaki
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Melbourne, Victoria, Australia.,Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Victor G Puelles
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Nephrology and Clinical Immunology, University Hospital RWTH Aachen, Aachen, Germany
| | - Luise A Cullen-McEwen
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Wendy E Hoy
- Centre for Chronic Disease, The University of Queensland, Brisbane, Australia
| | - Yusuke Okabayashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Kate M Denton
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, School of Biomedical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael D Hughson
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - John F Bertram
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, School of Biomedical Sciences, Monash University, Melbourne, Victoria, Australia
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Perlman S, Lotan D, Dekel B, Kivilevitch Z, Hazan Y, Achiron R, Gilboa Y. Prenatal compensatory renal growth in unilateral renal agenesis. Prenat Diagn 2017; 36:1075-1080. [PMID: 27734512 DOI: 10.1002/pd.4938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 10/04/2016] [Accepted: 10/05/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To create nomograms of fetal renal compensatory growth in cases of unilateral renal agenesis (URA). METHODS A retrospective study of fetuses with isolated URA diagnosed prenatally, and confirmed postnatal was performed. RESULTS Seventy-four fetuses with isolated solitary kidney were included in the study. A total of 134 measurements of the kidney's length were performed. Ninety five of them were studied longitudinally (2-6 measurements each). The raw values of the compensatory kidney demonstrated a significant correlation with gestational age (Pearson correlation coefficient 0.901, p < 0.001). A quadratic/cubic regression curve, both, described best this relationship, -26.400 + 3.004*GA, -0.026*GA2 (r2 = 0.819). The Z score between the mean predicted compensatory kidney's length, per week of gestation, and the mean predicted values of normal kidney length as previously published in the literature, progressively increased during pregnancy (cubic r2 = 0.946 and 0.260). CONCLUSION Cases of URA show a unique growth pattern of the single kidney from second trimester to term. Postnatal renal function is dependent on adequate intra-uterine compensatory growth; the presented nomograms provide insight into renal prognosis and add paramount information to the multidisciplinary prenatal counseling of the future parents. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sharon Perlman
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dani Lotan
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Division of Pediatric Nephrology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Benjamin Dekel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Division of Pediatric Nephrology, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel.,Pediatric Stem Cell Research Institute, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Zvi Kivilevitch
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yinon Hazan
- Ultrasound Unit, Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel.,Hadassah School of Medicine, Hebrew University, Jerusalem, Israel
| | - Reuven Achiron
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yinon Gilboa
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Cerqueira DM, Bodnar AJ, Phua YL, Freer R, Hemker SL, Walensky LD, Hukriede NA, Ho J. Bim gene dosage is critical in modulating nephron progenitor survival in the absence of microRNAs during kidney development. FASEB J 2017; 31:3540-3554. [PMID: 28446592 PMCID: PMC5503708 DOI: 10.1096/fj.201700010r] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/11/2017] [Indexed: 12/18/2022]
Abstract
Low nephron endowment at birth has been associated with an increased risk for developing hypertension and chronic kidney disease. We demonstrated in an earlier study that conditional deletion of the microRNA (miRNA)-processing enzyme Dicer from nephron progenitors results in premature depletion of the progenitors and increased expression of the proapoptotic protein Bim (also known as Bcl-2L11). In this study, we generated a compound mouse model with conditional deletion of both Dicer and Bim, to determine the biologic significance of increased Bim expression in Dicer-deficient nephron progenitors. The loss of Bim partially restored the number of nephron progenitors and improved nephron formation. The number of progenitors undergoing apoptosis was significantly reduced in kidneys with loss of a single allele, or both alleles, of Bim compared to mutant kidneys. Furthermore, 2 miRNAs expressed in nephron progenitors (miR-17 and miR-106b) regulated Bim levels in vitro and in vivo Together, these data suggest that miRNA-mediated regulation of Bim controls nephron progenitor survival during nephrogenesis, as one potential means of regulating nephron endowment.-Cerqueira, D. M., Bodnar, A. J., Phua, Y. L., Freer, R., Hemker, S. L., Walensky, L. D., Hukriede, N. A., Ho, J. Bim gene dosage is critical in modulating nephron progenitor survival in the absence of microRNAs during kidney development.
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Affiliation(s)
- Débora M Cerqueira
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Andrew J Bodnar
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yu Leng Phua
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rachel Freer
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shelby L Hemker
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Loren D Walensky
- Department of Pediatric Oncology and the Linde Program in Cancer Chemical Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil A Hukriede
- Department of Developmental Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacqueline Ho
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA;
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Affiliation(s)
- Jennifer R Charlton
- Department of Pediatrics, Division of Nephrology, University of Virginia School of Medicine, Charlottesville, Virginia; and
| | - Carolyn L Abitbol
- Department of Pediatrics, Division of Pediatric Nephrology, University of Miami Miller School of Medicine, Miami, Florida
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Abstract
Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.
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Umbilical artery histomorphometry: a link between the intrauterine environment and kidney development. J Dev Orig Health Dis 2017; 8:349-356. [PMID: 28260559 DOI: 10.1017/s2040174417000113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Prematurity is a risk factor for hypertension, vascular stiffness, nephron deficit and adult onset cardiorenal disease. The vascular tree and kidneys share morphogenic drivers that promote maturation in utero before 36 weeks of gestation. Vascular elastin accrual terminates after birth leaving collagen to promote vascular stiffness. Our objective was to determine if the histomorphometry of the umbilical artery, an extension of the aorta, parallels nephron mass across gestational age groups. From a cohort of 54 newborns, 32 umbilical cord specimens were adequate for evaluation. The umbilical cord was sectioned, stained with trichrome, and digitalized. Muscular and collagenous areas of the umbilical artery were measured in pixels using the Image J 1.48q software. Total kidney volume was measured by ultrasound and factored by body surface area (TKV/BSA). The umbilical artery total area was significantly greater in term v. preterm infants (9.3±1.3 v. 7.0±2.0 mm2; P<0.05) and increased with gestational age; while the percent muscular and collagen areas were independent of gestational age (R 2=0.04; P=ns). Percent muscular area correlated positively with TKV/BSA (r=0.53; P=0.002); while an increase in collagen correlated inversely with kidney mass (r=-0.53; P=0.002). In conclusion, an enhanced % muscular area and presumed vascular elasticity was associated with increased renal mass in all infants. Umbilical artery histomorphometry provides a link between the intrauterine environment, vascular and kidney development.
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Assessment of kidney function in preterm infants: lifelong implications. Pediatr Nephrol 2016; 31:2213-2222. [PMID: 26846786 DOI: 10.1007/s00467-016-3320-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/20/2015] [Accepted: 12/31/2015] [Indexed: 01/18/2023]
Abstract
This educational review will highlight the historical and contemporary references that establish a basic understanding of measurements of kidney function in the neonate and its relevance for the life of an individual. Importantly, the differential renal function of preterm infants relative to term infants has become paramount with the increased viability of preterm infants and the realization that kidney function is associated with gestational age. Moreover, neonatal kidney function is primarily associated with absolute renal mass and hemodynamic stability. Neonatal kidney function and its early developmental progression predict lifelong cardiovascular and renal disease risks. Validation of estimation equations of kidney function in this population has provided important reference data for other investigations and a clinical basis for prospective and longitudinal follow-up. Future research should be directed towards a better understanding of surrogate markers of kidney function from infancy through adulthood. Pediatric nephrologists should be aware of the developmental aspects of kidney function including the importance of the congenital nephron endowment and the preservation of kidney function throughout a lifetime. • Nephrogenesis occurs in utero in concert with other organ systems by branching morphogenesis, including the lungs, pancreas, and vascular tree, with over 60 % of nephrons being formed during the last trimester. • Infants born preterm before 36 weeks' gestation are in active nephrogenesis and are at increased risk of having a decreased nephron endowment from prenatal and postnatal genetic and epigenetic hazards that will impact the patient for a lifetime. • Post-natal adaptation of kidney function is directly proportional to the number of perfused nephrons, estimated by total kidney volume (TKV), mean arterial pressure (MAP), and gestational age. • Accurate measurement of glomerular filtration rate (GFR) in infants is problematic due to the unavailability of the gold standard inulin. The traditional use of creatinine to estimate GFR is unreliable in preterm infants due to its tubular reabsorption by immature kidneys and its dependence on muscle mass as an endogenous marker. Alternative endogenous markers to estimate GFR are cystatin C and beta trace protein (BTP). • Long-term follow-up of renal function in those born preterm should be life long and should include assessment of GFR, total kidney volume (TKV) relative to body surface area (BSA), and cardiovascular risks including hypertension and vascular stiffness.
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Sugimoto K, Miyazawa T, Nishi H, Miyazaki K, Enya T, Okada M, Takemura T. Heterozygous p.S811F RET gene mutation associated with renal agenesis, oligomeganephronia and total colonic aganglionosis: a case report. BMC Nephrol 2016; 17:146. [PMID: 27717313 PMCID: PMC5055680 DOI: 10.1186/s12882-016-0354-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 09/21/2016] [Indexed: 12/26/2022] Open
Abstract
Background Several shared common gene networks participate in development of interstinal ganglia and also nephron formation; the glial cell line-derived neurotrophic factor/Ret/glial cell line-derived neurotrophic factor receptor gene network is particularly important. Case presentation We encountered a patient with total colonic aganglionosis as well as right renal agenesis and oligomeganephronia. Gene analysis in this patient disclosed a heterozygous p.S811F mutation was in Ret gene exon 14, resulting in a substitution of phenylalanine for serine. The large side chain of phenylalanine obstructed the opening of the hydrophobic pocket of the Ret molecule causing interference with its interaction with adenosine triphosphate and consequent marked reduction in its enzyme activity. This could account for our patient's severe intestinal disease and renal dysplasia. We know of no previous reports of concomitant Hirschsprung’s disease and oligomeganephronia. Conclusions The patient's overall illness could be considered a novel Ret gene mutation syndrome.
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Affiliation(s)
- Keisuke Sugimoto
- Department of Pediatrics, Kindai University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan
| | - Tomoki Miyazawa
- Department of Pediatrics, Kindai University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan
| | - Hitomi Nishi
- Department of Pediatrics, Kindai University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan
| | - Kohei Miyazaki
- Department of Pediatrics, Kindai University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan
| | - Takuji Enya
- Department of Pediatrics, Kindai University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan
| | - Mitsuru Okada
- Department of Pediatrics, Kindai University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan
| | - Tsukasa Takemura
- Department of Pediatrics, Kindai University School of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, 589-8511, Japan.
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Prognostic factors and biomarkers of congenital obstructive nephropathy. Pediatr Nephrol 2016; 31:1411-20. [PMID: 26667236 DOI: 10.1007/s00467-015-3291-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022]
Abstract
Congenital obstructive nephropathy (CON) is the leading cause of chronic kidney disease (CKD) in children. Anomalies of the urinary tract are often associated with abnormal nephrogenesis, which is compounded by obstructive injury and by maternal risk factors associated with low birth weight. Currently available fetal and postnatal imaging and analytes of amniotic fluid, urine, or blood lack predictive value. For ureteropelvic junction obstruction, biomarkers are needed for optimal timing of pyeloplasty; for posterior urethral valves, biomarkers of long-term prognosis and CKD are needed. The initial nephron number may be a major determinant of progression of CKD, and most patients with CON who progress to renal failure reach this point in adulthood, presumably compounded by episodes of acute kidney injury. Biomarkers of tubular injury may be of particular value in predicting the need for surgical intervention or in tracking progression of CKD, and must be adjusted for patient age. Discovery of new biomarkers may depend on "unbiased" proteomics, whereby patterns of urinary peptide fragments from patients with CON are analyzed in comparison to controls. Most promising are the analysis of urinary exosomes (restricting biomarkers to relevant tubular cells) and quantitative magnetic resonance imaging techniques allowing precise determination of nephron number and tubular mass. The greatest need is for large prospective multicenter studies with centralized biomarker sample repositories to follow patients with CON from fetal life through adulthood.
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Kaczmarczyk M, Loniewska B, Kuprjanowicz A, Binczak-Kuleta A, Goracy I, Ryder M, Taryma-Lesniak O, Ciechanowicz A. Association Between RET (rs1800860) and GFRA1 (rs45568534, rs8192663, rs181595401, rs7090693, and rs2694770) Variants and Kidney Size in Healthy Newborns. Genet Test Mol Biomarkers 2016; 20:624-628. [PMID: 27533506 DOI: 10.1089/gtmb.2016.0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Abnormal congenital nephron number has been implicated in the pathogenesis of hypertension and renal disease. The RET receptor complex propagates signals essential for nephrogenesis and the RET c.1296G>A polymorphism, leading to aberrant splicing of exon 7, is associated with reduced kidney volume, a surrogate for nephron endowment. The glial cell-derived neurotrophic factor (GDNF) family receptor alpha 1 (GFRA1) is a component of the RET receptor complex, and three alternatively spliced GFRA1 transcripts (with or without exon 5) have been identified. In rats, exclusion of exon 5 results in stronger GDNF binding affinity and RET activation. The aims of this study were to investigate further the relationship between RET c.1296G>A and kidney volume, and also to investigate the association between the GFRA1 polymorphisms near and within the alternatively spliced exon 5, as well as the functional 5'-UTR c.-193C>G with kidney volume. MATERIALS AND METHODS The study included 188 healthy full-term newborns. Genotyping of the RET (NM_020975.4:c.1296G>A, rs1800860) and GFRA1 (NM_005264.5:c.-193C>G, rs45568534; c.419-87A>G, rs8192663; c.429G>A, rs181595401; c.433+127A>G, rs7090693; c.433+245A>G, rs2694770) polymorphisms was performed using polymerase chain reaction-restriction fragment length polymorphism, minisequencing, or sequencing. Total kidney volume (TKV) was determined by ultrasound and normalized to body surface area (TKV/BSA). Both marker-by-marker and haplotype-based methods were used to test for associations between polymorphisms and TKV/BSA. RESULTS TKV/BSA in RET c.1296A allele carriers was significantly lower compared with GG homozygotes (103 ± 23 vs. 110 ± 19 mL/m2, p = 0.034). c.429G>A was invariant in our sample. There was no association between any of the GFRA1 polymorphisms and renal volume. CONCLUSIONS RET c.1296A may be a common susceptibility allele for nephron underdosing-related diseases. The 5'-UTR and intronic variants near exon 5 of GFRA1 are not associated with nephron endowment.
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Affiliation(s)
- Mariusz Kaczmarczyk
- 1 Department of Clinical and Molecular Biochemistry, Pomeranian Medical University , Szczecin, Poland
| | - Beata Loniewska
- 2 Department of Neonatal Diseases, Pomeranian Medical University , Szczecin, Poland
| | - Anna Kuprjanowicz
- 3 Department of Radiology, Pomeranian Medical University , Szczecin, Poland
| | - Agnieszka Binczak-Kuleta
- 1 Department of Clinical and Molecular Biochemistry, Pomeranian Medical University , Szczecin, Poland
| | - Iwona Goracy
- 1 Department of Clinical and Molecular Biochemistry, Pomeranian Medical University , Szczecin, Poland
| | - Malgorzata Ryder
- 1 Department of Clinical and Molecular Biochemistry, Pomeranian Medical University , Szczecin, Poland
| | - Olga Taryma-Lesniak
- 1 Department of Clinical and Molecular Biochemistry, Pomeranian Medical University , Szczecin, Poland
| | - Andrzej Ciechanowicz
- 1 Department of Clinical and Molecular Biochemistry, Pomeranian Medical University , Szczecin, Poland
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Epistatic interaction between common AGT G(-6)A (rs5051) and AGTR1 A1166C (rs5186) variants contributes to variation in kidney size at birth. Gene 2015; 572:72-78. [PMID: 26142106 DOI: 10.1016/j.gene.2015.06.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 06/02/2015] [Accepted: 06/29/2015] [Indexed: 11/22/2022]
Abstract
Low nephron number has been recognised as an important cardiovascular risk factor and recently a strong correlation between renal mass and nephron number has been demonstrated in newborns. The aim of this study was to investigate individual, as well as combined, effects of common variants of genes which encode for major components of the renin-angiotensin system (REN G10601A, AGT G(-6)A, ACE I/D, AGTR1 A1166C) on kidney size in healthy, full-term newborns. A significant additive main effect of the ACE I/D polymorphism, as well as an additive-by-additive interaction between AGT G(-6)A and AGTR1 A1166C variants, were found. The variance attributed to the epistatic effect was 27.9 ml(2)/m(4), which accounted for 73.8% of the interaction variance (37.8 ml(2)/m(4)), 66.4% of the genetic variance (42.0 ml(2)/m(4)) and 4.4% to the total phenotypic variance (628 ml(2)/m(4)). No other statistically significant main or epistatic effects were detected. Our results highlight the importance of considering gene-gene interactions as part of the genetic architecture of congenital nephron number, even when the loci do not show significant single locus effects. Unravelling the genetic determinants of low nephron number, along with early molecular screening, may well help to identify children at risk for cardiovascular disease.
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A new serum cystatin C formula for estimating glomerular filtration rate in newborns. Pediatr Nephrol 2015; 30:1297-305. [PMID: 25956698 DOI: 10.1007/s00467-014-3029-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/10/2014] [Accepted: 10/23/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND The levels of serum cystatin C (CysC) and creatinine (Cr) were determined in small-for-gestational-age (SGA) babies and compared with those for normal term newborns appropriate for gestational age (AGA), at birth and 3 days later. We then compared a number of cysC-based, Cr-based and combined formulas for estimation of glomerular filtration rate (GFR) with the neonatal reference GFR. METHODS Fifty full-term SGA and 50 AGA newborns were enrolled in the study. Kidney volume measurements were performed by ultrasound for each newborn. RESULTS At birth, the mean level of CysC in SGA babies was 1.48 ± 0.30 mg/l in cord blood and 1.38 ± 0.18 mg/l in day 3 blood samples, and the mean Cr level, determined simultaneously, was 67.08 ± 17.62 and 55.62 ± 14.91 μmol/l, respectively. These levels did not differ significantly from those determined in AGA babies. A 10 % reduction in kidney volume was associated with an increase in CysC value of 9.3 % in cord blood. The Cr-based and Schwartz-combined equations underestimated GFR relative to CysC-based and Zappitelli-based equations at birth and 3 days later. CONCLUSIONS A newly constructed Cys-C based formula which includes kidney volume and body surface area in the calculations for GFR is a reliable marker of GFR compared with neonatal reference clearance values.
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Kanzaki G, Tsuboi N, Haruhara K, Koike K, Ogura M, Shimizu A, Yokoo T. Factors associated with a vicious cycle involving a low nephron number, hypertension and chronic kidney disease. Hypertens Res 2015; 38:633-41. [PMID: 26084263 DOI: 10.1038/hr.2015.67] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 03/23/2015] [Accepted: 03/26/2015] [Indexed: 12/15/2022]
Abstract
It has been reported that there is substantial variation in the nephron number between individuals. Previous studies using autopsy kidneys have demonstrated that a low nephron number, in relation to a low birth weight, may result in hypertension (HTN) and/or chronic kidney disease (CKD). However, recent studies have revealed that the association between a low nephron number and HTN is not a universal finding. This observation indicates that a low nephron number is unlikely to be the sole factor contributing to an elevated blood pressure. In addition to the nephron number, various genetic and congenital factors may contribute to increased susceptibility to HTN and/or CKD in a complex manner. Acquired factors, including aging, obesity and related metabolic abnormalities, and various causes of renal injury, may additionally promote further nephron loss. Such a vicious cycle may induce HTN and/or CKD via the common mechanisms of renal hemodynamic maladaptation.
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Affiliation(s)
- Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kotaro Haruhara
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Ogura
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Stangenberg S, Chen H, Wong MG, Pollock CA, Saad S. Fetal programming of chronic kidney disease: the role of maternal smoking, mitochondrial dysfunction, and epigenetic modfification. Am J Physiol Renal Physiol 2015; 308:F1189-96. [DOI: 10.1152/ajprenal.00638.2014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/29/2015] [Indexed: 12/22/2022] Open
Abstract
The role of an adverse in utero environment in the programming of chronic kidney disease in the adult offspring is increasingly recognized. The cellular and molecular mechanisms linking the in utero environment and future disease susceptibility remain unknown. Maternal smoking is a common modifiable adverse in utero exposure, potentially associated with both mitochondrial dysfunction and epigenetic modification in the offspring. While studies are emerging that point toward a key role of mitochondrial dysfunction in acute and chronic kidney disease, it may have its origin in early development, becoming clinically apparent when secondary insults occur. Aberrant epigenetic programming may add an additional layer of complexity to orchestrate fibrogenesis in the kidney and susceptibility to chronic kidney disease in later life. In this review, we explore the evidence for mitochondrial dysfunction and epigenetic modification through aberrant DNA methylation as key mechanistic aspects of fetal programming of chronic kidney disease and discuss their potential use in diagnostics and targets for therapy.
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Affiliation(s)
- Stephanie Stangenberg
- Kolling Institute, Department of Medicine, Royal North Shore Hospital and University of Sydney, St. Leonards, Sydney, New South Wales, Australia; and
| | - Hui Chen
- School of Medical and Molecular Biosciences, Faculty of Science, Centre for Health Technology, University of Technology, Sydney, New South Wales, Australia
| | - Muh Geot Wong
- Kolling Institute, Department of Medicine, Royal North Shore Hospital and University of Sydney, St. Leonards, Sydney, New South Wales, Australia; and
| | - Carol A. Pollock
- Kolling Institute, Department of Medicine, Royal North Shore Hospital and University of Sydney, St. Leonards, Sydney, New South Wales, Australia; and
| | - Sonia Saad
- Kolling Institute, Department of Medicine, Royal North Shore Hospital and University of Sydney, St. Leonards, Sydney, New South Wales, Australia; and
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The Fate of Nephrons in Congenital Obstructive Nephropathy: Adult Recovery is Limited by Nephron Number Despite Early Release of Obstruction. J Urol 2015; 194:1463-72. [PMID: 25912494 DOI: 10.1016/j.juro.2015.04.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/23/2022]
Abstract
PURPOSE Urinary tract obstruction and reduced nephron number often occur together as a result of maldevelopment of the kidneys and the urinary tract. We determined the role of nephron number on adaptation of the remaining nephrons of mice subjected to neonatal partial unilateral ureteral obstruction followed through adulthood. MATERIALS AND METHODS Wild-type and Os/+ mice (the latter with 50% fewer nephrons) underwent sham operation or partial unilateral ureteral obstruction in the first 2 days of life. Additional mice underwent release of unilateral ureteral obstruction at 7 days. All kidneys were harvested at 3 weeks (weaning) or 6 weeks (adulthood). Glomerular number and area, glomerulotubular junction integrity, proximal tubular volume fraction and interstitial fibrosis were measured by histomorphometry. RESULTS In the obstructed kidney unilateral ureteral obstruction caused additional nephron loss in Os/+ but not in wild-type mice. Glomerular growth from 3 to 6 weeks was impaired by ipsilateral obstruction and not preserved by release in wild-type or Os/+ mice. Proximal tubular growth was impaired and interstitial collagen was increased by ipsilateral obstruction in all mice. These conditions were attenuated by release of unilateral ureteral obstruction in wild-type mice but were not restored in Os/+ mice. Unilateral ureteral obstruction increased interstitial collagen in the contralateral kidney while release of obstruction enhanced tubular growth and reduced interstitial collagen. CONCLUSIONS Unilateral ureteral obstruction in early postnatal development impairs adaptation to reduced nephron number and induces additional nephron loss despite release of obstruction. Premature and low birth weight infants with congenital obstructive nephropathy are likely at increased risk for progression of chronic kidney disease.
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