title: Renal consequences of preterm birth.
abstract: BACKGROUND
  The developmental origin of health and disease concept identifies the brain, cardiovascular, liver, and kidney systems as targets of fetal adverse programming with adult consequences. As the limits of viability in premature infants have been pushed to lower gestational ages, the long-term impact of prematurity on kidneys still remains a significant burden during hospital stay and beyond.
  
  
  OBJECTIVE
  The purpose of this study is to summarize available evidence, mechanisms, and short- and long-term renal consequences of prematurity and identify nephroprotective strategies and areas of uncertainty.
  
  
  RESULTS
  Kidney size and nephron number are known to be reduced in surviving premature infants due to disruption of organogenesis at a crucial developmental time point. Inflammation, hyperoxia, and antiangiogenic factors play a role in epigenetic conditioning with potential life-long consequences. Additional kidney injury from hypoperfusion and nephrotoxicity results in structural and functional changes over time which are often unnoticed. Nephropathy of prematurity and acute kidney injury confound glomerular and tubular maturation of preterm kidneys. Kidney protective strategies may ameliorate growth failure and suboptimal neurodevelopmental outcomes in the short term. In later life, subclinical chronic renal disease may progress, even in asymptomatic survivors.
  
  
  CONCLUSIONS
  Awareness of renal implications of therapeutic interventions and renal conservation efforts may lead to a variety of short and long-term benefits. Adequate monitoring and supplementation of microelement losses, gathering improved data on renal handling, and exploration of new avenues such as reliable markers of injury and new therapeutic strategies in contemporary populations, as well as long-term follow-up of renal function, is warranted.
authors.affiliation: Department of Pediatrics, Section of Neonatology, University of Calgary, Cumming School of Medicine, 780-1403 29th St NW, Calgary, AB, T2N 2T9, Canada. Amelie.Stritzke@albertahealthservices.ca.
authors.forename: Amelie
authors.identifier: http://orcid.org/0000-0003-4809-0765
authors.initials: A
authors.lastname: Stritzke
authors.affiliation: Department of Pediatrics, Section of Neonatology, University of Calgary, Cumming School of Medicine, C536-1403 29St Nw, Calgary, AB, T2N2T9, Canada.
authors.forename: Sumesh
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Pediatrics, University of Calgary, C4-615 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada.
authors.forename: Harish
authors.initials: H
authors.lastname: Amin
authors.affiliation: Division of Neonatology, Department of Pediatrics, McMaster University, Room 4F5, 1280, Main Street West, Hamilton, Ontario, L8S4K1, Canada.|Department of Pediatrics, General Hospital, Paracelsus Medical School, South Campus, Breslauer Str. 201, 90471, Nuernberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Fusch
authors.affiliation: Department of Pediatrics and Community Health Sciences, Alberta Children's Hospital Research Institute, University of Calgary, C211C 1403 29St NW, Calgary, AB, T2N 2T9, Canada.
authors.forename: Abhay
authors.initials: A
authors.lastname: Lodha
keywords: Acute kidney injury; Developmental origin of health and disease; Fetal origin of adult disease; Kidney disease; Nephrotoxicity; Prematurity; Renal development; Tubulopathy of prematurity