Nephron Number Reduction and Low Birth Weight: A Concern for the Paediatrician and Beyond

The impact on adult disease, of prenatal programming and of the environment during infancy has been widely described. Yet the increased morbidity due to this prenatal and neonatal environment seems to occur ever more early. Indeed, recent studies detected the consequences of prenatal programming in childhood, making it also an immediate concern for paediatricians. This review, focusing on oligonephropathy, aimed to give an up-dated view on when prenatal-programmed morbidity is first detectable, and on possible preventive strategies and treatments. As renal morbidity related to prenatal programming has been diagnosed in early childhood, at only two years old, it is now urgent to evaluate early strategies such as sports, low-protein or iron diets and antiproteinuric drugs, preventing an accentuation of glomerulosclerosis. A yearly follow-up seems appropriate for patients born small for gestation or preterm, including the measure of blood pressure and of albuminuria. A diet preventing protein and salt excess, and a smoking prohibition could delay the onset of glomerulosclerosis. The yearly follow-up would allow to diagnose it early enough to administer angiotensin converting enzyme inhibitors delaying the progression of renal sclerosis.