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Review
. 2023 Feb 10;15(1):143-153.
doi: 10.3390/pediatric15010012.

CAKUT: A Pediatric and Evolutionary Perspective on the Leading Cause of CKD in Childhood

Robert L Chevalier  1
Affiliations
Review

CAKUT: A Pediatric and Evolutionary Perspective on the Leading Cause of CKD in Childhood

Robert L Chevalier. Pediatr Rep. .

Abstract

The global prevalence of chronic kidney disease (CKD) is increasing rapidly, due to increasing environmental stressors through the life cycle. Congenital anomalies of kidney and urinary tract (CAKUT) account for most CKD in children, with a spectrum that can lead to kidney failure from early postnatal to late adult life. A stressed fetal environment can impair nephrogenesis, now recognized as a significant risk factor for the development of adult CKD. Congenital urinary tract obstruction is the leading cause of CKD due to CAKUT and can itself impair nephrogenesis as well as contribute to progressive nephron injury. Early diagnosis by ultrasonography in fetal life by an obstetrician/perinatologist can provide important information for guiding prognosis and future management. This review focuses on the critical role played by the pediatrician in providing timely evaluation and management of the patient from the moment of birth to the transfer to adult care. In addition to genetic factors, vulnerability of the kidney to CKD is a consequence of evolved modulation of nephron number in response to maternal signaling as well as to susceptibility of the nephron to hypoxic and oxidative injury. Future advances in the management of CAKUT will depend on improved biomarkers and imaging techniques.

Keywords: chronic kidney disease; congenital anomalies of the kidney and urinary tract (CAKUT); evolution; pediatrics.

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Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1
Figure 1
Life course of the CAKUT patient: Chronic kidney disease progression and environmental stressors.
Figure 2
Figure 2
Life course of the CAKUT patient: Genetic determinants, evolutionary determinants, clinical diagnosis and intervention.
See this image and copyright information in PMC

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References

    1. Xie Y., Bowe B., Mokdad A.H., Xian H., Yan Y., Li T., Maddukuri G., Tsai C.Y., Floyd T., Al-Aly Z. Analysis of the Global Burden of Disease study highlights the global, regional, and national trends of chronic kidney disease epidemiology from 1990 to 2016. Kidney Int. 2018;94:567–581. doi: 10.1016/j.kint.2018.04.011. - DOI - PubMed
    1. Becherucci F., Roperto R.M., Materassi M., Romagnani P. Chronic kidney disease in children. Clin. Kidney J. 2016;9:583–591. doi: 10.1093/ckj/sfw047. - DOI - PMC - PubMed
    1. Barker D.J.P. The origins of the developmental origins theory. J. Intern. Med. 2007;261:412–417. doi: 10.1111/j.1365-2796.2007.01809.x. - DOI - PubMed
    1. Eriksson J.G., Salonen M.K., Kajantie E., Osmond C. Prenatal Growth and CKD in Older Adults: Longitudinal Findings From the Helsinki Birth Cohort Study, 1924–1944. Am. J. Kidney Dis. 2018;71:20–26. doi: 10.1053/j.ajkd.2017.06.030. - DOI - PubMed
    1. Calderon-Margalit R., Golan E., Twig G., Leiba A., Tzur D., Afek A., Skorecki K., Vivante A. History of Childhood Kidney Disease and Risk of Adult End-Stage Renal Disease. N. Engl. J. Med. 2018;378:428–438. doi: 10.1056/NEJMoa1700993. - DOI - PubMed

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