4.2. Blood Pressure
chronic kidney disease, congenital deficiency, renal failure, hypertension, glomerular sclerosis
SYSTEMIC HYPERTENSION, HYPERTENSION, RENAL FAILURE, SYSTEMIC HYPERTENSION, WHITE COAT HYPERTENSION, DISEASE, GLOMERULAR SCLEROSIS, COMPENSATORY HYPERTROPHY
Systolic blood pressure at 11 years in our cohort was positively associated with maternal smoking during pregnancy and feeding with the higher-protein formula. These findings support the hypothesis that early developmental and environmental factors have a principal role in future health, as pointed out by the Developmental Origins of Health and Disease hypothesis [The positive correlation between kidney volume at 11 years and systolic blood pressure was unexpected. In 1988, Brenner suggested that a congenital deficiency in glomerular filtration surface area contributes to a limited ability to excrete a sodium load, leading to volume-dependent systemic hypertension. Systemic hypertension will generate hyperfiltration and glomerular capillary hypertension, which will lead eventually to glomerular sclerosis, decreasing, even further, the glomerular filtration area, and thus aggravating hypertension and susceptibility to renal failure [To date, no clinical accessible method exists to measure the nephron number, so we cannot be certain whether the higher kidney volume associated with higher protein ingestion in the first months of life is due to compensatory hypertrophy and will eventually lead to glomerular sclerosis and the development of hypertension and chronic kidney disease in adult life.An interesting study conducted in rats demonstrated that early overfeeding (protein and calories) leads to a higher body mass index, kidney weight, glomeruli number (nephrogenesis continues after birth in rats), and blood pressure in adult rats, but also a higher number and larger distribution of senescent cells in the kidneys at weaning [The main limitations in our study are the high rate of loss to follow-up at 11 years and the lack of data on creatinine or cystatin to assess glomerular function. Moreover, blood pressure was measured in only one appointment, so overestimation of blood pressure values or white coat hypertension cannot be ruled out.