Protecting Kidney Health in the First 1000 Days: The Pediatrician’s Role in Safeguarding the Weakest

Kidney development in the first 1000 days of life is vulnerable to numerous prenatal, perinatal, and congenital factors. This review aims to analyze the main determinants of early kidney development and to highlight the role of pediatricians in identifying at-risk infants and implementing preventive strategies to reduce the risk of chronic kidney disease (CKD). For at-risk newborns, early assessment of kidney size and function is essential for the timely detection of functional decline. Key risk factors include prenatal exposures, perinatal complications, genetic conditions, and postnatal factors. Early, tailored nephrological follow-up is crucial for preventing CKD and its complications. Determining optimal monitoring intervals through clinical, laboratory, and ultrasound evaluations enables risk stratification, ensuring closer surveillance for the most vulnerable infants during this critical window. This review integrates evidence from experimental, epidemiological, and clinical studies and highlights the importance of early-life interventions in shaping renal health across the lifespan.