A life course approach to preventing chronic kidney disease by limiting long-term consequences of early adverse events

Abstract

The global epidemic of chronic kidney disease (CKD) is becoming well recognised. Current CKD treatment strategies, however, focus on using drugs to protect kidneys in clinically overt nephropathies together with the optimisation of dialysis and transplantation techniques. Here, a complementary perspective is made, starting with a focus on early adverse events, or ‘hits’, that perturb the prenatal development or early postnatal maturation of the kidney. A more widespread awareness of these genetic and environmental hits may inform the prevention of CKD and severe kidney failure occurring later in life. Furthermore, we consider whether measurement of emerging urine biomarkers of nephron number and kidney cell senescence in young people might usefully inform kidney prognosis and treatment as well as identifying individuals for potential clinical trials of novel drugs. Finally, we indicate some key unanswered questions in this field and discuss translational research pathways to assess and identify new treatments.