The Effect of the In utero Environment on Nephrogenesis and Renal Function

The developmental origins of health and disease hypothesis suggests that a suboptimal in utero environment may contribute to detrimental long-term health outcomes. Factors such as poor maternal diet, elevated concentrations of maternal stress hormones, or hypoxia can result in adaptations in the fetus to ensure short-term survival. However, these adaptations may alter aspects of normal development and result in offspring at increased risk of chronic disease, particularly hypertension and renal dysfunction. The kidney has been identified as exquisitely sensitive to a range of common prenatal perturbations resulting in the formation of reduced numbers of nephrons. This is associated with changes in renal branching morphogenesis and rates of apoptosis, and alterations in the renal renin angiotensin system. Continuing research to fully elucidate the molecular signaling pathways involved, including the potential role of epigenetics, is required to gain an understanding of how prenatal insults result in decreased nephron formation and subsequent adult-onset disease