Peer-reviewed article
Early-Life Oxidative Stress and Pediatric Kidney Disease: From Developmental Programming to Preventive Strategies.
Luca Pecoraro, Alessio Signore, Andrea Dell'Anna, Giulia Carrino, Ilenia Chillura et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines how oxidative stress during the first 1000 days of life may damage developing kidneys and increase the risk of kidney disease later in childhood and adulthood. The authors identify multiple risk factors including maternal health problems, premature birth, poor fetal growth, and nutritional deficiencies that can interfere with normal kidney development. While experimental evidence suggests oxidative stress plays a role, the review concludes that current clinical evidence does not yet support routine antioxidant supplements or screening for oxidative stress markers in children. The authors recommend instead identifying at-risk children early and ensuring appropriate medical care and optimization of modifiable factors.
Key points
- The first 1000 days of life are critical for kidney development; oxidative stress during this period may reduce the number of nephrons and increase later risk of hypertension and chronic kidney disease
- Risk factors include maternal metabolic and nutritional conditions, prematurity, impaired fetal growth, perinatal interventions, poor nutrition, inflammation, and environmental exposures
- Clinical studies show increased kidney disease risk following prematurity and impaired fetal growth, but oxidative stress has not been established as the causal mechanism
- Current evidence for antioxidant supplements and oxidative stress biomarker screening in children is predominantly preclinical and does not support routine use
- Practical clinical strategies include early identification of risk factors, appropriate clinical assessment, optimizing modifiable exposures, and referral to pediatric nephrology when needed
Limitations
This is a narrative review that synthesizes existing literature rather than presenting new empirical data. The authors acknowledge that while associations between early-life factors and later kidney disease are documented, the specific role of oxidative stress as a causal mechanism remains unclear based on current clinical evidence.
Abstract
The first 1000 days of life represent a critical window for renal development and long-term kidney health. During this period, oxidative stress and mitochondrial dysfunction may disrupt nephrogenesis, renal maturation, and redox-sensitive developmental pathways, potentially contributing to reduced nephron endowment and greater susceptibility to hypertension and chronic kidney disease later in life. This narrative review examines prenatal, perinatal, and early postnatal factors that may contribute to oxidative renal injury, including maternal metabolic and nutritional conditions, prematurity, impaired fetal growth, perinatal interventions, early-life nutritional and inflammatory factors, and environmental exposures. Particular attention is given to the concept of renal vulnerability and to the distinction between clinical evidence of long-term kidney risk and experimental evidence supporting potential mechanisms of developmental renal programming. Clinical cohort data indicate an increased risk of kidney disease later in life following prematurity and impaired fetal growth, although these associations do not establish oxidative stress as a causal mediator. We also discuss preventive and emerging reprogramming strategies. While mitochondrial-targeted, nutritional, and antioxidant approaches remain promising, current evidence is predominantly preclinical and does not support routine antioxidant supplementation or screening for oxidative stress biomarkers in children. From a practical pediatric perspective, early identification of relevant risk factors, appropriate clinical assessment, optimization of modifiable exposures, and individualized referral to pediatric nephrology represent the most clinically relevant strategies for protecting long-term kidney health.