Loss of a kidney during fetal life: long-term consequences and lessons learned.
Epidemiological studies reveal that children born with a solitary functioning kidney (SFK) have a greater predisposition to develop renal insufficiency and hypertension in early adulthood. A congenital SFK is present in patients with unilateral renal agenesis or unilateral multicystic kidney dysplasia, leading to both structural and functional adaptations in the remaining kidney, which act to mitigate the reductions in glomerular filtration rate and sodium excretion that would otherwise ensue. To understand the mechanisms underlying the early development of renal insufficiency in children born with a SFK, we established a model of fetal uninephrectomy (uni-x) in sheep, a species that similar to humans complete nephrogenesis before birth. This model results in a 30% reduction in nephron number rather than 50%, due to compensatory nephrogenesis in the remaining kidney. Similar to children with a congenital SFK, uni-x sheep demonstrate a progressive increase in arterial pressure and a loss of renal function with aging. This review summarizes the compensatory changes in renal hemodynamics and tubular sodium handling that drive impairments in renal function and highlights the existence of sex differences in the functional adaptations following the loss of a kidney during fetal life.
Bldg. 13F, Dept. of Physiology, Monash Univ., Victoria, Australia 3800. kate.denton@monash.edu.
Yugeesh R
YR
Lankadeva
Reetu R
RR
Singh
Marianne
M
Tare
Karen M
KM
Moritz
Kate M
KM
Denton
D000328:Adult; D000375:Aging; D000818:Animals; D002648:Child; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007223:Infant; D007668:Kidney / Q000002:abnormalities* / Q000196:embryology* / Q000503:physiopathology; D007671:Kidney Concentrating Ability / Q000502:physiology; D007674:Kidney Diseases / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D023421:Models, Animal; D009392:Nephrectomy / Q000009:adverse effects; D009399:Nephrons / Q000196:embryology; D009569:Nitric Oxide / Q000502:physiology; D051381:Rats; D012737:Sex Factors; D012756:Sheep / Q000601:surgery; D014564:Urogenital Abnormalities / Q000503:physiopathology*; D009396:Wilms Tumor / Q000601:surgery
D009569:Nitric Oxide
aging; hypertension; nitric oxide; renal compensatory growth tubular sodium reabsorption; renin angiotensin system; vasopressin