Does undernutrition during development program renal glomerular injury and hypertension? -From animal studies to patients

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In advanced countries, the number of low birth weight (LBW) babies increased. Moreover, adverse events during development increase vulnerability tocardiovascular and renal disease in later life. To determine whether reduced nutrition duringdevelopment leads to focal segmental glomeruloscleorsis (FSGS), we conducted translationalresearch from an avian model to children diagnosed by renal biopsies. Japanese quail in which5-10% egg white was withdrawn (EwW) before incubation had lower BW than controls. EwWbirds also had a reduced hatching rate and smaller glomeruli. Furthermore, plasmaglucocorticoid levels and glomerular apoptosis were higher in perinatal EwW quail, leading tothe decrease in number of glomeruli in adult. In glomerular podocytes from mature EwW quail,intercellular adhesion molecules and slit diaphragms were well maintained, whereas capillaryloops showed focal ballooning; laminin-positive substance was accumulated in the mesangium.Thirty-three percent (33%) of chidren diagnosed by renal biopsies (n = 206) conducted atNiigata University since 1990 as having FSGS (n = 15) had LBW. The LBW-FSGS childrenshowed glomeruli with sclerotic lesions significantly more than normal BW-FSGS children, andthe number of podocytes was lower. Damaged or incompletely mature mesangium providesreduced architectural support and may trigger the nephrosclerosis. The results from the animalexperiments agree with the clinical observations. LBW may be deemed a risk factor for FSGS.