Chevalier Robert L
Department of Pediatrics, The University of Virginia, Charlottesville, VA 22908, USA.
Pediatr Rep. 2023 Feb 10;15(1):143-153. doi: 10.3390/pediatric15010012.
The global prevalence of chronic kidney disease (CKD) is increasing rapidly, due to increasing environmental stressors through the life cycle. Congenital anomalies of kidney and urinary tract (CAKUT) account for most CKD in children, with a spectrum that can lead to kidney failure from early postnatal to late adult life. A stressed fetal environment can impair nephrogenesis, now recognized as a significant risk factor for the development of adult CKD. Congenital urinary tract obstruction is the leading cause of CKD due to CAKUT and can itself impair nephrogenesis as well as contribute to progressive nephron injury. Early diagnosis by ultrasonography in fetal life by an obstetrician/perinatologist can provide important information for guiding prognosis and future management. This review focuses on the critical role played by the pediatrician in providing timely evaluation and management of the patient from the moment of birth to the transfer to adult care. In addition to genetic factors, vulnerability of the kidney to CKD is a consequence of evolved modulation of nephron number in response to maternal signaling as well as to susceptibility of the nephron to hypoxic and oxidative injury. Future advances in the management of CAKUT will depend on improved biomarkers and imaging techniques.
由于生命周期中环境压力源的增加，慢性肾脏病（CKD）的全球患病率正在迅速上升。先天性肾脏和尿路异常（CAKUT）是儿童CKD的主要原因，其范围可导致从出生后早期到成年后期的肾衰竭。应激的胎儿环境会损害肾发生，现在这被认为是成人CKD发展的一个重要危险因素。先天性尿路梗阻是CAKUT导致CKD的主要原因，其本身会损害肾发生，并导致进行性肾单位损伤。产科医生/围产医学专家在胎儿期通过超声检查进行早期诊断，可以为指导预后和未来管理提供重要信息。本综述重点关注儿科医生在从出生到转至成人护理期间为患者提供及时评估和管理方面所起的关键作用。除了遗传因素外，肾脏对CKD的易感性是肾单位数量响应母体信号而进化调节以及肾单位对缺氧和氧化损伤易感性的结果。CAKUT管理的未来进展将取决于改进的生物标志物和成像技术。
