Environmental exposures and pediatric kidney health

Environmental exposures are increasingly associated with kidney and cardiometabolic disease in children. This review summarizes current understanding of the potentially hazardous effects of air pollution, chemical toxicants, and heavy metal contamination on pediatric kidney health and cardiometabolic risk factors for chronic kidney disease (CKD), as well as the potentially protective effect of green space. We highlight the critical windows of childhood development, during which the kidneys may have varying susceptibility to environmental exposures. We also discuss challenges and possible solutions to adequately powered studies at the intersection of environmental health and pediatric kidney disease. Environmental exposures are both ubiquitous and modifiable. Therefore, elucidating the contribution of environmental exposures to the increasing global burden of CKD will be crucial to informing strategies for kidney disease prevention, starting in childhood. IMPACT: We summarize current evidence on the associations between environmental exposures-including air pollution, chemical toxicants, and heavy metal contamination-and pediatric kidney disease and related cardiometabolic risk factors, as well as the potentially protective effect of green space. We highlight how the impact of environmental exposures on the kidneys may vary during different critical windows of childhood development. Lastly, we discuss methodological challenges and potential solutions, such as using novel technologies and approaches to adequately power studies toward the goal of environmental intervention for chronic kidney disease (CKD) prevention.