Division of Nephrology, University of Alberta, Edmonton, AB, Canada.
Lancet. 2013 Jul 20;382(9888):273-83. doi: 10.1016/S0140-6736(13)60311-6. Epub 2013 May 31.
Developmental programming of non-communicable diseases is now an established paradigm. With respect to hypertension and chronic kidney disease, adverse events experienced in utero can affect development of the fetal kidney and reduce final nephron number. Low birthweight and prematurity are the most consistent clinical surrogates for a low nephron number and are associated with increased risk of hypertension, proteinuria, and kidney disease in later life. Rapid weight gain in childhood or adolescence further compounds these risks. Low birthweight, prematurity, and rapid childhood weight gain should alert clinicians to an individual's lifelong risk of hypertension and kidney disease, prompting education to minimise additional risk factors and ensuring follow-up. Birthweight and prematurity are affected substantially by maternal nutrition and health during pregnancy. Optimisation of maternal health and early childhood nutrition could, therefore, attenuate this programming cycle and reduce the global burden of hypertension and kidney disease in the future.
非传染性疾病的发育编程现在已经是一个既定的模式。就高血压和慢性肾病而言，胎儿期经历的不良事件会影响胎儿肾脏的发育，并减少最终的肾单位数量。低出生体重和早产是肾单位数量少的最一致的临床替代指标，与成年后患高血压、蛋白尿和肾脏疾病的风险增加相关。儿童期或青春期体重快速增加会进一步增加这些风险。低出生体重、早产和儿童期体重快速增加应引起临床医生对个体终生患高血压和肾脏疾病风险的警惕，促使他们进行教育以尽量减少其他风险因素，并确保进行随访。出生体重和早产在很大程度上受到孕妇在怀孕期间的营养和健康状况的影响。因此，优化母婴健康和儿童早期营养可以减轻这种编程循环，并减少未来全球高血压和肾脏疾病的负担。
