Urologic care and progression to end-stage kidney disease: a Chronic Kidney Disease in Children (CKiD) nested case-control study

Understanding Similarities and Differences in CKD and Dialysis Care in Children and Adults

In lower-income settings there is often a dearth of resources and nephrologists, especially pediatric nephrologists, and individual physicians often find themselves caring for patients with chronic kidney diseases and end-stage kidney failure across the age spectrum. The management of such patients in high-income settings is relatively protocolized and permits high-volume services to run efficiently. The basic principles of managing chronic kidney disease and providing dialysis are similar for adults and children, however, given the differences in body size, causes of kidney failure, nutrition, and growth between children and adults with kidney diseases, nephrologists must understand the relevance of these differences, and have an approach to providing quality and safe dialysis to each group. Prevention, early diagnosis, and early intervention with simple therapeutic and lifestyle interventions are achievable goals to manage symptoms, complications, and reduce progression, or avoid kidney failure in children and adults. These strategies currently are easier to implement in higher-resource settings with robust health systems. In many low-resource settings, kidney diseases are only first diagnosed at end stage, and resources to pay out of pocket for appropriate care are lacking. Many barriers therefore exist in these settings, where specialist nephrology personnel may be least accessible. To improve management of patients at all ages, we highlight differences and similarities, and provide practical guidance on the management of children and adults with chronic kidney disease and kidney failure. It is important that children are managed with a view to optimizing growth and well-being and maximizing future options (eg, maintaining vein health and optimizing cardiovascular risk), and that adults are managed with attention paid to quality of life and optimization of physical health.

Chronic kidney disease causes and outcomes in children: Perspective from a LMIC setting

Background and objective

Chronic kidney disease (CKD) constitutes a major public health challenge, with a global prevalence of 15–74.7 cases /million children. Preventing CKD in children, slowing its progression and management of complications are essential, especially in challenged health systems in low middle income countries (LMIC). We conducted a retrospective review to assess the underlying cause and stage of CKD at presentation and clinical outcomes in children and adolescents at the Indus Hospital and Health Network (IHHN) in Karachi, Pakistan.

Methods

Children 0–16 years with CKD stage 1 and/or higher at presentation were included. Data including demographics, clinical status and lab results at presentation and during follow-up, surgical intervention if any, kidney function at last visit and outcome at last follow-up was recorded.

Results

A total of 229 children diagnosed with CKD are included in our study. The median age at diagnosis was 10 years with male: female ratio of 1.8:1. Only 5% children presented in stage 1 CKD. The rate of adverse outcomes is 4.5 times higher in children with CKD stage 3–5 compared to early CKD. Congenital anomaly of kidney and urinary tract (CAKUT) was the underlying cause in 49% children. Children with glomerular disease had comparatively worse outcome. Proteinuria, hypertension, anemia and bone disease were associated with high morbidity and mortality.

Conclusion

The true epidemiology of childhood CKD is unknown in Pakistan. Our cohort showed better CKD outcomes in children diagnosed early with appropriate surgical and medical follow-up. Prompt diagnosis, treatment and prevention of progression can be life-saving in our setting. CKD registry data can inform policy changes that can prevent poor outcomes.

Diagnosis and grading of vesicoureteral reflux on voiding cystourethrography images in children using a deep hybrid model

BACKGROUND AND OBJECTIVE

Vesicoureteral reflux is the leakage of urine from the bladder into the ureter. As a result, urinary tract infections and kidney scarring can occur in children. Voiding cystourethrography is the primary radiological imaging method used to diagnose vesicoureteral reflux in children with a history of recurrent urinary tract infection. Besides the diagnosis of reflux, it is graded with voiding cystourethrography. In this study, we aimed to diagnose and grade vesicoureteral reflux in Voiding cystourethrography images using hybrid CNN in deep learning methods.

METHODS

Images of pediatric patients diagnosed with VUR between 2016 and 2021 in our hospital (Firat University Hospital) were graded according to the international vesicoureteral reflux radiographic grading system. VCUG images of 236 normal and 992 with vesicoureteral reflux pediatric patients were available. A total of 6 classes were created as normal and graded 1-5 patients.

RESULTS

In this study, a hybrid-based mRMR (Minimum Redundancy Maximum Relevance) using CNN (Convolutional Neural Networks) model is developed for the diagnosis and grading of vesicoureteral reflux on voiding cystourethrography images. Googlenet, MobilenetV2, and Densenet201 models are used as a part of the hybrid architecture. The obtained features from these architectures are examined in concatenating process. Then, these features are classified in machine learning classifiers after optimizing with the mRMR method. Among the models used in the study, the highest accuracy value was obtained in the proposed model with an accuracy rate of 96.9%.

CONCLUSIONS

It shows that the hybrid model developed according to the findings of our study can be used in the diagnosis and grading of vesicoureteral reflux in voiding cystourethrography images.