Pathophysiology of Fetal and Neonatal Kidneys
Fetal renal development is a complex phenomenon. The ureteric bud and metanephric mesenchyme interaction is essential for nephrogenesis which results from the expression of specific genes, the fetal environment, or the interaction of both factors. IUGR, maternal diabetes, maternal undernutrition, micronutrient deficiency, and fetal or neonatal exposure to drugs (NSAIDS, ACE-Is, glucocorticoids, aminoglycosides) or to toxic (alcohol) are known to affect nephrogenesis. After a brief review of fetal and neonatal renal physiology, pathologic situations including preterm birth, congenital anomalies of the kidney and urinary tract, kidney diseases, and kidney-pharmacology interactions will be developed. Renal maldevelopment and exposure to factors that can alter the fetal and neonatal renal functions and structure increase the risk of hypertension and chronic renal disease in adulthood. Long-term follow-up is thus required and early markers of nephron dosing and renal injury should be developed with the aim to implement preventive strategies.
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