Renal programming: Cause for concern?

The development of the kidney can be altered in utero in response to a sub-optimal environment. The intrarenal factors that have been most well characterised as being sensitive to programming events are kidney mass/ nephron endowment, the renin-angiotensin system, tubular sodium handling and the renal sympathetic nerves. Newborns that have been subjected to an adverse intrauterine environment may thus begin life at a distinct disadvantage, in terms of renal function, at a time when the kidney must take over the role the primary role for extracellular fluid homeostasis from the placenta. A poor beginning, causing renal programming, has been linked to increased risk of hypertension and renal disease in adult hood. However, though a cause for concern, increasingly evidence demonstrates that renal programming is not a fait accompli in terms of future cardiovascular and renal disease. A greater understanding of postnatal renal maturation and the impact of secondary factors (genes, sex, diet, stress and disease) on this process is required to predict which babies are at risk of increased cardiovascular and renal disease as adults, and to be able to devise preventative measures.