Climate change and its influence in nephron mass

Abstract

Purpose of review: The consequences of climate change, including heat and extreme weather events impact kidney function in adults and children. The impacts of climate change on kidney development during gestation and thereby on kidney function later in life have been poorly described. Clinical evidence is summarized to highlight possible associations between climate change and nephron mass.

Recent findings: Pregnant women are vulnerable to the effects of climate change, being less able to thermoregulate, more sensitive to the effects of dehydration, and more susceptible to infections. Exposure to heat, wildfire smoke, drought, floods and climate-related infections are associated with low birth weight, preterm birth and preeclampsia. These factors are associated with reduced nephron numbers, kidney dysfunction and higher blood pressures in offspring in later life. Exposure to air pollution is associated with higher blood pressures in children and has variable effects on estimated glomerular filtration rate.

Summary: Climate change has important impacts on pregnant women and their unborn children. Being born too small or too soon is associated with life-time risk of kidney disease. Climate change may therefore have a dual effect of impacting fetal kidney development and contributing to cumulative postnatal kidney injury. The impact on population kidney health of future generations may be significant.

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FIGURE 1

Potential impact of climate change on kidney development and developmental programming of blood pressure and kidney function in later life. The dashed arrows symbolize the hypothetical pathways based on available evidence from animal data and limited clinical data. The solid arrows symbolize the pathways with the strongest evidence available. Importantly other noncommunicable diseases are also associated with developmental programming – especially cardiovascular disease and diabetes – which may additionally impact kidney disease risk in later life. DM, diabetes mellitus; LBW, low birth weight; RAAS, renin–angiotensin–aldosterone system; SGA, small for gestational age; SNS, sympathetic nervous system.

FIGURE 2

Simultaneous impact of climate change. Diverse impact of increasing heat on factors which may impact fetal kidney development: reduce crop yields and reduce protein and micronutrient content of crops; direct impact of heat on pregnant women who are less able to thermoregulate; increasing risk of vector borne diseases which impact pregnancy outcomes. Reproduced with permission under Attribution 4.0 International (CC BY 4.0) from Romanello et al., J Paediatr Child Health, Vol. 57, Issue: 11, pp. 1736–1740 [11^▪].