Environmental influences on renal tract development: a focus on maternal diet and the glucocorticoid hypothesis

Introduction

When I was at medical school thirty years ago I remember being taught that each normal human kidney contained one million glomeruli. Recent studies, using the most accurate technique called „stereology”, reveal that adult kidneys actually contain a strikingly wide range of glomerular numbers, from about one quarter to two million per kidney [1] [2] [3] [4]. Although atrophy of existing glomeruli may occur with normal ageing [2], it seems reasonable to assume that most of this variation is explained by congenital differences in glomerular numbers.

Indeed, earlier studies had suggested that kidneys of low birthweight babies contained fewer glomeruli than kidneys of babies of normal birth weight [5] [6]. Adults with a history of essential hypertension have on average only half as many glomeruli per kidney as normotensive individuals [1]. Very low birth weight individuals [7] and individuals with congenital solitary functioning kidneys [8], both presumed to have a lower total glomerular complement than normal, appear to be at increased risk of acquiring clinically significant glomerulosclerosis in later life. Furthermore, a low birth weight predicts an aggrevated course [e. g. need for antihypertensive drugs] in children with iodiopathic nephrotic syndrome [9] and may confer a higher risk of developing end-stage renal failure in a wide range of both primary congenital and also acquired kidney diseases [10]. These human observations are consistent with some animal studies. For example, sheep which had undergone fetal uninephrectomy, and thus have a congenital deficit of glomeruli, have accelerated age-related decline in renal function and systemic hypertension [11].

Note: Adult kidneys contain from about one quarter to two million glomeruli.

References

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