23 - The developmental environment, renal function and disease

Summary

Introduction

Chronic renal disease is a major health problem in many societies. In some populations, including the Australian Aborigine, the Pima Indians of the USA, and certain populations of African-Americans, diseased kidneys due to chronic hypertension progress into end-stage renal disease, with a particularly high incidence (Hoy et al. 1999, Kett and Bertram 2004). The American Kidney Foundation estimates that as many as 20 million Americans, or approximately 10% of adults in the population, have some form of renal disease. Not only is it the ninth leading cause of death in Americans, but treatment for patients with chronic renal failure is amongst the most expensive for any chronic disease. The causes of kidney disease are numerous, including inherited and congenital renal defects, but by far the greatest risk factors are diabetes and hypertension. Similar to other adult-onset diseases, such as hypertension and diabetes mellitus, lifestyle factors such as a high-fat/high-salt diet, smoking and lack of exercise can contribute significantly to the development of renal disease. Epidemiological and experimental evidence is accumulating to suggest that, as with hypertension and diabetes, the susceptibility of an individual to develop renal disease may be increased if that person has been exposed to a poor or suboptimal intrauterine environment. If a substantive link can be proven between abnormal kidney development and the later development of hypertension and renal disease, then measures can be recommended which could decrease significantly the incidence of adult hypertension.