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Harita Y. Urinary extracellular vesicles in childhood kidney diseases. Pediatr Nephrol 2024; 39:2293-2300. [PMID: 38093081 PMCID: PMC11199279 DOI: 10.1007/s00467-023-06243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 06/26/2024]
Abstract
Most biological fluids contain extracellular vesicles (EVs). EVs are surrounded by a lipid bilayer and contain biological macromolecules such as proteins, lipids, RNA, and DNA. They lack a functioning nucleus and are incapable of replicating. The physiological characteristics and molecular composition of EVs in body fluids provide valuable information about the status of originating cells. Consequently, they could be effectively utilized for diagnostic and prognostic applications. Urine contains a heterogeneous population of EVs. To date, these urinary extracellular vesicles (uEVs) have been ignored in the standard urinalysis. In recent years, knowledge has accumulated on how uEVs should be separated and analyzed. It has become clear how uEVs reflect the expression of each molecule in cells in nephron segments and how they are altered in disease states such as glomerular/tubular disorders, rare congenital diseases, acute kidney injury (AKI), and chronic kidney disease (CKD). Significant promise exists for the molecular expression signature of uEVs detected by simple techniques such as enzyme-linked immunosorbent assay (ELISA), making them more applicable in clinical settings. This review presents the current understanding regarding uEVs, emphasizing the potential for non-invasive diagnostics, especially for childhood kidney diseases.
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Affiliation(s)
- Yutaka Harita
- Department of Pediatrics, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
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2
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Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, Herrington WG, Hill G, Inker LA, Kazancıoğlu R, Lamb E, Lin P, Madero M, McIntyre N, Morrow K, Roberts G, Sabanayagam D, Schaeffner E, Shlipak M, Shroff R, Tangri N, Thanachayanont T, Ulasi I, Wong G, Yang CW, Zhang L, Levin A. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int 2024; 105:S117-S314. [PMID: 38490803 DOI: 10.1016/j.kint.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 03/17/2024]
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Baseline characteristics of participants enrolled in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Pediatr Nephrol 2022; 37:3177-3187. [PMID: 35277754 DOI: 10.1007/s00467-021-05278-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/04/2021] [Accepted: 08/20/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND We developed the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD) as a subcohort of KNOW-CKD to investigate the different characteristics of pediatric CKD between countries and races. METHODS Children aged younger than 18 years with stage 1 ~ 5 CKD were recruited at seven major pediatric nephrology centers in Korea. Blood and urine samples, as well as demographic and clinical data, were collected. From 2011 to 2016, 458 children were enrolled, and the baseline profiles of 437 children were analyzed. RESULTS The median age of the cohort was 10.9 years old, and 68.0% were males. The median estimated glomerular filtration rate was 53.1 mL/min/1.73 m2. The most common etiology of CKD was congenital anomalies of the kidney and urinary tract (42.6%), followed by glomerulopathies (25.6%). CONCLUSION We report a cross-sectional analysis of the overall baseline characteristics such as age, CKD stage, and underlying kidney disease of the KNOW-Ped CKD. The cohort will be longitudinally followed for ten years. "A higher resolution version of the Graphical abstract is available as Supplementary information."
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Epidemiology of pediatric chronic kidney disease/kidney failure: learning from registries and cohort studies. Pediatr Nephrol 2022; 37:1215-1229. [PMID: 34091754 DOI: 10.1007/s00467-021-05145-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 05/02/2021] [Accepted: 05/18/2021] [Indexed: 01/13/2023]
Abstract
Although the concept of chronic kidney disease (CKD) in children is similar to that in adults, pediatric CKD has some peculiarities, and there is less evidence and many factors that are not clearly understood. The past decade has witnessed several additional registry and cohort studies of pediatric CKD and kidney failure. The most common underlying disease in pediatric CKD and kidney failure is congenital anomalies of the kidney and urinary tract (CAKUT), which is one of the major characteristics of CKD in children. The incidence/prevalence of CKD in children varies worldwide. Hypertension and proteinuria are independent risk factors for CKD progression; other factors that may affect CKD progression are primary disease, age, sex, racial/genetic factors, urological problems, low birth weight, and social background. Many studies based on registry data revealed that the risk factors for mortality among children with kidney failure who are receiving kidney replacement therapy are younger age, female sex, non-White race, non-CAKUT etiologies, anemia, hypoalbuminemia, and high estimated glomerular filtration rate at dialysis initiation. The evidence has contributed to clinical practice. The results of these registry-based studies are expected to lead to new improvements in pediatric CKD care.
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Wehedy E, Shatat IF, Al Khodor S. The Human Microbiome in Chronic Kidney Disease: A Double-Edged Sword. Front Med (Lausanne) 2022; 8:790783. [PMID: 35111779 PMCID: PMC8801809 DOI: 10.3389/fmed.2021.790783] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is an increasing global health burden. Current treatments for CKD include therapeutics to target factors that contribute to CKD progression, including renin–angiotensin–aldosterone system inhibitors, and drugs to control blood pressure and proteinuria control. Recently, associations between chronic disease processes and the human microbiota and its metabolites have been demonstrated. Dysbiosis—a change in the microbial diversity—has been observed in patients with CKD. The relationship between CKD and dysbiosis is bidirectional; gut-derived metabolites and toxins affect the progression of CKD, and the uremic milieu affects the microbiota. The accumulation of microbial metabolites and toxins is linked to the loss of kidney functions and increased mortality risk, yet renoprotective metabolites such as short-chain fatty acids and bile acids help restore kidney functions and increase the survival rate in CKD patients. Specific dietary interventions to alter the gut microbiome could improve clinical outcomes in patients with CKD. Low-protein and high-fiber diets increase the abundance of bacteria that produce short-chain fatty acids and anti-inflammatory bacteria. Fluctuations in the urinary microbiome are linked to increased susceptibility to infection and antibiotic resistance. In this review, we describe the potential role of the gut, urinary and blood microbiome in CKD pathophysiology and assess the feasibility of modulating the gut microbiota as a therapeutic tool for treating CKD.
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Affiliation(s)
- Eman Wehedy
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Research Department, Sidra Medicine, Doha, Qatar
| | | | - Souhaila Al Khodor
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Research Department, Sidra Medicine, Doha, Qatar
- *Correspondence: Souhaila Al Khodor
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Morohashi T, Wada N, Odaira S, Shimizu S, Takahashi S, Morioka I. β2-microglobulin measurement with dried urine spots for congenital anomalies of the kidney and urinary tract screening in 3-year-old children. Pediatr Int 2022; 64:e15077. [PMID: 34850504 DOI: 10.1111/ped.15077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Screening using dipstick urinalysis has long been performed in 3-year-old children; however, it is ineffective in detecting congenital anomalies of the kidney and urinary tract (CAKUT). Measurement of the urinary β2-microglobulin (β2MG)/creatinine (Cr) ratio may be more effective for this purpose. Analysis of dried urine spots (DUS) on filter paper is suitable for mass screening since operational costs are low and samples are easy to collect and transport. We examined the accuracy of measuring the urinary β2MG/Cr ratio in DUS on filter paper. METHODS We collected 2,623 urine samples from 3-year-old children. β2MG and Cr levels were measured in DUS on filter paper. We examined the correlation between the β2MG/Cr ratios measured in DUS and using the conventional method in 640 samples using the coefficient of determination test. Children with high β2MG/Cr ratios (>0.6 µg/mg Cr) in DUS samples were further examined to establish a definitive diagnosis. RESULTS There was strong correlation between the two methods for determination of β2MG levels (r2 = 0.68; P < 0.001) and β2MG/Cr ratios (r2 = 0.69; P < 0.001). Of the 2,623 children, 38 (1.45%) had β2MG/Cr ratios >0.6. Thirty-five children were subsequently examined, resulting in findings of renal hypodysplasia (n = 2, 0.08%), horseshoe kidney (n = 1, 0.04%), renal tubular dysfunction with hepatoblastoma (n = 1, 0.04%), data abnormality (high urine β2MG level, n = 6, 0.23%; high serum Cr level, n = 1, 0.04%), and normal values (n = 24, 0.91%). CONCLUSIONS We evaluated a practical method for measuring β2MG/Cr ratios in DUS as a screening method to detect CAKUT in 3-year-old children.
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Affiliation(s)
- Tamaki Morohashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Naohiro Wada
- Department of Nephrology, Shizuoka Children's Hospital, Shizuoka, Japan
| | | | - Shoichi Shimizu
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | | | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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Shi X, Shi Y, Zhang L, Gan L, Zhong X, Huang Y, Yao C, Wang Y, Dong C, Liu B, Wang F, Wang H, Ding J. Analysis of chronic kidney disease among national hospitalization data with 14 million children. BMC Nephrol 2021; 22:195. [PMID: 34034665 PMCID: PMC8146197 DOI: 10.1186/s12882-021-02383-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The main purpose was to determine basic epidemiological data on CKD among hospitalized pediatric patients in China. METHODS Data from pediatric inpatients with CKD hospitalized from June 1, 2013 to May 31, 2017 were extracted from the electronic records of HQMS database, which includes over 14 million inpatients. Codes from the 10th revision of the International Classification of Diseases (ICD-10) were used to search the database. RESULTS A total of 524 primary diseases of CKD were included in this study. In all, there were 278 231 pediatric inpatients with CKD, which accounted for 1.95 % of the 14 250 594 pediatric inpatients registered in the HQMS database. The number of pediatric inpatients with CKD was 67 498 in 2013, 76 810 in 2014, 81 665 in 2015 and 82 649 in 2016, which accounted for 1.93 %, 1.93 %, 1.99 and 2.09 %, respectively, of the total population of pediatric inpatients. The etiology of CKD was secondary nephrosis in 37.95 % of cases, which ranked first and followed by CAKUT with a percentage of 24.61 %. Glomerular diseases and cystic kidney disease accounted for 21.18 and 5.07 %, respectively. Among all 278 231 patients, 6 581 (2.37 %) had a primary discharge diagnosis of CKD. The renal pathology findings of CKD showed that IgA accounted for 51.17 %. CONCLUSIONS This study provides a descriptive analysis of the hospitalized population of pediatric CKD patients. Our study provides important, fundamental data for policy making and legislation, registry implementation and the diagnosis, treatment and prevention of CKD in China.
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Affiliation(s)
- Xinmiao Shi
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- National Institute of Health Data Science at Peking University, Beijing, China
| | - Lanxia Gan
- China Standard Medical Information Research Center, Shenzhen, China
| | - Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yuming Huang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
| | - Chen Yao
- Department of Biostatistics, Peking University First Hospital, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
| | - Yanfang Wang
- Peking University Clinical Research Institute, Beijing, China
| | - Chongya Dong
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Beini Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen, China.
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
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8
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Plumb L, Boother EJ, Caskey FJ, Sinha MD, Ben-Shlomo Y. The incidence of and risk factors for late presentation of childhood chronic kidney disease: A systematic review and meta-analysis. PLoS One 2020; 15:e0244709. [PMID: 33382793 PMCID: PMC7774987 DOI: 10.1371/journal.pone.0244709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When detected early, inexpensive measures can slow chronic kidney disease progression to kidney failure which, for children, confers significant morbidity and impacts growth and development. Our objective was to determine the incidence of late presentation of childhood chronic kidney disease and its associated risk factors. METHODS We searched MEDLINE, Embase, PubMed, Web of Science, Cochrane Library and CINAHL, grey literature and registry websites for observational data describing children <21 years presenting to nephrology services, with reference to late presentation (or synonyms thereof). Independent second review of eligibility, data extraction, and risk of bias was undertaken. Meta-analysis was used to generate pooled proportions for late presentation by definition and investigate risk factors. Meta-regression was undertaken to explore heterogeneity. RESULTS Forty-five sources containing data from 30 countries were included, comprising 19,339 children. Most studies (37, n = 15,772) described children first presenting in kidney failure as a proportion of the chronic kidney disease population (mean proportion 0.43, 95% CI 0.34-0.54). Using this definition, the median incidence was 2.1 (IQR 0.9-3.9) per million age-related population. Risk associations included non-congenital disease and older age. Studies of hospitalised patients, or from low- or middle-income countries, that had older study populations than high-income countries, had higher proportions of late presentation. CONCLUSIONS Late presentation is a global problem among children with chronic kidney disease, with higher proportions seen in studies of hospitalised children or from low/middle-income countries. Children presenting late are older and more likely to have non-congenital kidney disease than timely presenting children. A consensus definition is important to further our understanding and local populations should identify modifiable barriers beyond age and disease to improve access to care.
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Affiliation(s)
- Lucy Plumb
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- UK Renal Registry, The Renal Association, Bristol, United Kingdom
| | - Emily J. Boother
- Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Fergus J. Caskey
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- Department of Renal Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Manish D. Sinha
- Department of Paediatric Nephrology, Evelina London Children’s Hospital, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- King’s British Heart Foundation Centre, King’s College London, London, United Kingdom
| | - Yoav Ben-Shlomo
- Population Health Sciences, University of Bristol Medical School, Bristol, United Kingdom
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
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9
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Gimpel C, Bergmann C, Bockenhauer D, Breysem L, Cadnapaphornchai MA, Cetiner M, Dudley J, Emma F, Konrad M, Harris T, Harris PC, König J, Liebau MC, Marlais M, Mekahli D, Metcalfe AM, Oh J, Perrone RD, Sinha MD, Titieni A, Torra R, Weber S, Winyard PJD, Schaefer F. International consensus statement on the diagnosis and management of autosomal dominant polycystic kidney disease in children and young people. Nat Rev Nephrol 2019; 15:713-726. [PMID: 31118499 PMCID: PMC7136168 DOI: 10.1038/s41581-019-0155-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
These recommendations were systematically developed on behalf of the Network for Early Onset Cystic Kidney Disease (NEOCYST) by an international group of experts in autosomal dominant polycystic kidney disease (ADPKD) from paediatric and adult nephrology, human genetics, paediatric radiology and ethics specialties together with patient representatives. They have been endorsed by the International Pediatric Nephrology Association (IPNA) and the European Society of Paediatric Nephrology (ESPN). For asymptomatic minors at risk of ADPKD, ongoing surveillance (repeated screening for treatable disease manifestations without diagnostic testing) or immediate diagnostic screening are equally valid clinical approaches. Ultrasonography is the current radiological method of choice for screening. Sonographic detection of one or more cysts in an at-risk child is highly suggestive of ADPKD, but a negative scan cannot rule out ADPKD in childhood. Genetic testing is recommended for infants with very-early-onset symptomatic disease and for children with a negative family history and progressive disease. Children with a positive family history and either confirmed or unknown disease status should be monitored for hypertension (preferably by ambulatory blood pressure monitoring) and albuminuria. Currently, vasopressin antagonists should not be offered routinely but off-label use can be considered in selected children. No consensus was reached on the use of statins, but mTOR inhibitors and somatostatin analogues are not recommended. Children with ADPKD should be strongly encouraged to achieve the low dietary salt intake that is recommended for all children.
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Affiliation(s)
- Charlotte Gimpel
- Division of Pediatric Nephrology, Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany.
| | - Carsten Bergmann
- Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Center for Human Genetics, Bioscientia, Ingelheim, Germany
| | - Detlef Bockenhauer
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Luc Breysem
- Department of Pediatric Radiology, University Hospital of Leuven, Leuven, Belgium
| | - Melissa A Cadnapaphornchai
- Rocky Mountain Pediatric Kidney Center, Rocky Mountain Hospital for Children at Presbyterian St Luke's Medical Center, Denver, CO, USA
| | - Metin Cetiner
- Department of Pediatrics II, University Hospital Essen, Essen, Germany
| | - Jan Dudley
- Renal Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Francesco Emma
- Division of Nephrology and Dialysis, Ospedale Pediatrico Bambino Gesù-IRCCS, Rome, Italy
| | - Martin Konrad
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Tess Harris
- PKD International, Geneva, Switzerland
- PKD Charity, London, UK
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Jens König
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Max C Liebau
- Department of Pediatrics and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matko Marlais
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Djalila Mekahli
- Department of Pediatric Nephrology, University Hospital of Leuven, Leuven, Belgium
- PKD Research Group, Laboratory of Pediatrics, Department of Development and Regeneration, GPURE, KU Leuven, Leuven, Belgium
| | - Alison M Metcalfe
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Jun Oh
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald D Perrone
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA
| | - Manish D Sinha
- Kings College London, Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Andrea Titieni
- Department of General Pediatrics, University Children's Hospital, Münster, Germany
| | - Roser Torra
- Department of Nephrology, University of Barcelona, Barcelona, Spain
| | - Stefanie Weber
- Department of Pediatrics, University of Marburg, Marburg, Germany
| | - Paul J D Winyard
- University College London, Great Ormond Street Hospital, Institute of Child Health, London, UK
| | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
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Costa FP, Simões E Silva AC, Mak RH, Ix JH, Vasconcelos MA, Dias CS, Fonseca CC, Oliveira MCL, Oliveira EA. A clinical predictive model of renal injury in children with isolated antenatal hydronephrosis. Clin Kidney J 2019; 13:834-841. [PMID: 33123360 PMCID: PMC7577777 DOI: 10.1093/ckj/sfz102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background Antenatal hydronephrosis (ANH) affects ∼1-5% of pregnancies. The aim of this study was to develop a clinical prediction model of renal injury in a large cohort of infants with isolated ANH. Methods This is a longitudinal cohort study of 447 infants with ANH admitted since birth between 1989 and 2015 at a tertiary care center. The primary endpoint was time until the occurrence of a composite event of renal injury, which includes proteinuria, hypertension and chronic kidney disease (CKD). A predictive model was developed using a Cox proportional hazards model and evaluated by C-statistics. Results Renal pelvic dilatation (RPD) was classified into two groups [Grades 1-2 (n = 255) versus Grades 3-4 (n = 192)]. The median follow-up time was 6.4 years (interquartile range 2.8-12.5). Thirteen patients (2.9%) developed proteinuria, 6 (1.3%) hypertension and 14 (3.1%) CKD Stage 2. All events occurred in patients with RPD Grades 3-4. After adjustment, three covariables remained as predictors of the composite event: creatinine {hazard ratio [HR] 1.27, [95% confidence interval (CI) 1.05-1.56]}, renal parenchyma thickness at birth [HR 0.78(95% CI 0.625-0.991)] and recurrent urinary tract infections [HR 4.52 (95% CI 1.49-13.6)]. The probability of renal injury at 15 years of age was estimated as 0, 15 and 24% for patients assigned to the low-risk, medium-risk and high-risk groups, respectively (P < 0.001). Conclusion Our findings indicate an uneventful clinical course for patients with Society for Fetal Urology (SFU) Grades 1-2 ANH. Conversely, for infants with SFU Grades 3-4 ANH, our prediction model enabled the identification of a subgroup of patients with increased risk of renal injury over time.
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Affiliation(s)
- Fernanda P Costa
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ana C Simões E Silva
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, USA
| | - Joachim H Ix
- Division of Nephrology-Hypertension, University of California, San Diego, San Diego, CA, USA
| | - Mariana A Vasconcelos
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Cristiane S Dias
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Carolina C Fonseca
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Maria Christina L Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Eduardo A Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology of Molecular Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.,Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, San Diego, CA, USA
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11
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Poggiali IV, Simões E Silva AC, Vasconcelos MA, Dias CS, Gomes IR, Carvalho RA, Oliveira MCL, Pinheiro SV, Mak RH, Oliveira EA. A clinical predictive model of renal injury in children with congenital solitary functioning kidney. Pediatr Nephrol 2019; 34:465-474. [PMID: 30324507 DOI: 10.1007/s00467-018-4111-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/13/2018] [Accepted: 10/02/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Solitary functioning kidney (SFK) is an important condition in the spectrum of congenital anomalies of the kidney and urinary tract. The aim of this study was to describe the risk factors for renal injury in a cohort of patients with congenital SFK. METHODS In this retrospective cohort study, 162 patients with SFK were systematically followed up (median, 8.5 years). The primary endpoint was time until the occurrence of a composite event of renal injury, which includes proteinuria, hypertension, and chronic kidney disease (CKD). A predictive model was developed using Cox proportional hazards model and evaluated by c statistics. RESULTS Among 162 children with SFK included in the analysis, 132 (81.5%) presented multicystic dysplastic kidney, 20 (12.3%) renal hypodysplasia, and 10 (6.2%) unilateral renal agenesis. Of 162 patients included in the analysis, 10 (6.2%) presented persistent proteinuria, 11 (6.8%) had hypertension, 9 (5.6%) developed CKD stage ≥ 3, and 18 (11%) developed the composite outcome. After adjustment by the Cox model, three variables remained as independent predictors of the composite event: creatinine (HR, 3.93; P < 0.001), recurrent urinary tract infection (UTI) (HR, 5.05; P = 0.002), and contralateral renal length at admission (HR, 0.974; P = 0.002). The probability of the composite event at 10 years of age was estimated as 3%, 11%, and 56% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). CONCLUSION Our findings have shown an overall low risk of renal injury for most of infants with congenital SFK. Nevertheless, our prediction model enabled the identification of a subgroup of patients with an increased risk of renal injury over time.
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Affiliation(s)
- Isabel V Poggiali
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Cristina Simões E Silva
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Mariana A Vasconcelos
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Cristiane S Dias
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Izabella R Gomes
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rafaela A Carvalho
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Maria Christina L Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Sergio V Pinheiro
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Eduardo A Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil. .,Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA.
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Progression of chronic kidney disease in children - role of glomerular hemodynamics and interstitial fibrosis. Curr Opin Pediatr 2018; 30:220-227. [PMID: 29389683 DOI: 10.1097/mop.0000000000000594] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to provide an overview of the current advances in the understanding of the mechanisms involved in the progression of chronic kidney disease (CKD) with emphasis on the role of glomerular hemodynamics and tubulointerstitial fibrosis. RECENT FINDINGS Despite the varied causes of CKD, the progressive destruction of renal tissue processes through a complex common pathway. Current studies have highlighted both the role of the abnormal intrarenal hemodynamics and of the activation of fibrogenic biochemical pathway in the replacement of normal renal structure by extracellular matrix and ultimately by fibrosis. Molecular markers with the potential to contribute to the detection of tubular cell damage and tubulointerstitial fibrosis in the kidney has been identified. SUMMARY There is a clear need to understand and elucidate the mechanisms of progression of CKD to develop efficient therapeutic strategies to halt decline of renal function in children.
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13
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Chen H, Shinzawa M, Tokumasu H, Tanaka S, Kawakami K. Short sleep and risk of proteinuria in 3-year-olds in Japan: a population-based cohort study. Sleep Med 2017; 40:33-39. [PMID: 29221775 DOI: 10.1016/j.sleep.2017.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To examine whether short sleep at 18 months of age is associated with risk of proteinuria at 3 years of age. METHODS A population-based cohort study using municipal health check-up data from 62,623 children born between March 1, 2004, and April 30, 2011, and followed to 3 years via questionnaire in Kobe City, Japan. Sleep duration was calculated from wake time and bedtime at the 18-month health check-up by standardized parent-reported questionnaires. Proteinuria, defined as dipstick urinary protein of ≥1+, was measured by dipstick urinalysis at 3 years. Multivariable logistic regression was used to generate adjusted olds ratios. RESULTS In total, 2253 (3.6%) children had short nighttime sleep (≤8 h) at 18 months. At 3 years, 765 (1.2%) children had proteinuria. The adjusted odds ratio for proteinuria among children with 8 h of sleep or less versus those with normal sleep of 10 h per night was 1.50 (95% confidence interval, 1.07-2.11; P = 0.02). Odds ratios of the same direction but weaker magnitude were observed for children with bedtime at 22:00 or later, and those with wake time at 6:00 or earlier. CONCLUSIONS Short sleep at 18 months was associated with risk of proteinuria at 3 years. Future research is warranted to examine whether sleep programs targeting early childhood may have additional potential health benefits for kidney development.
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Affiliation(s)
- Hongyan Chen
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Maki Shinzawa
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan; Department of Geriatric Medicine and Nephrology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hironobu Tokumasu
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shiro Tanaka
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.
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14
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Nakano M, Uemura O, Honda M, Ito T, Nakajima Y, Saitoh S, Saitoh S. Development of tandem mass spectrometry-based creatinine measurement using dried blood spot for newborn mass screening. Pediatr Res 2017; 82:237-243. [PMID: 28422942 DOI: 10.1038/pr.2017.56] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 02/23/2017] [Indexed: 12/25/2022]
Abstract
BackgroundCongenital anomalies of the kidney and urinary tract (CAKUT) are the most prevalent etiologies of pediatric chronic kidney disease (CKD). However, no robust mass screening methods have been developed to detect patients with CAKUT, making early intervention to prevent progressive renal failure challenging.MethodsWe applied tandem mass spectrometry (MS/MS) to measure the creatinine (Cr) value from dried blood spot (DBS) analysis, which has been used for newborn mass screening. Subsequently, we evaluated the correlation between DBS Cr measured by MS/MS and serum Cr measured by the conventional method in pediatric patients with CKD. Finally, DBS Cr was measured in 190 full-term, healthy newborns on days 4-6 after birth.ResultsWe established a system of MS/MS-based measurement of Cr from DBS. Measured DBS Cr in the pediatric patients showed a strong association with serum Cr (r=0.86; P<0.01). The median DBS Cr value in newborns was 0.222 (interquartile range: 0.189, 0.269) mg/dl. No significant correlations were found between DBS Cr values and body weight, Apgar score, gestational age, and sex in newborns.ConclusionWe successfully established a method for MS/MS-based measurement of Cr for newborn screening and determined normal reference values for full-term newborns.
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Affiliation(s)
- Masaru Nakano
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Osamu Uemura
- Japanese Red Cross Toyota College of Nursing, Toyota, Japan
| | - Masataka Honda
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Tetsuya Ito
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Yoko Nakajima
- Department of Pediatrics, Fujita Health University, Toyoake, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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15
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Fathallah-Shaykh SA. Proteinuria and progression of pediatric chronic kidney disease: lessons from recent clinical studies. Pediatr Nephrol 2017; 32:743-751. [PMID: 27350622 DOI: 10.1007/s00467-016-3448-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 12/29/2022]
Abstract
Proteinuria in children with chronic kidney disease (CKD) is common and its etiology differs from that in adults. How proteinuria influences the rate of progression of CKD has been analyzed in multiple retrospective clinical studies and more recently in a few prospective ones. In this review I summarize the results, strengths and weaknesses of each of these studies. The findings of several retrospective studies in children with CKD have confirmed what we have learned from adult studies on the association between proteinuria and worsening kidney function. Larger prospective clinical studies have examined the effects of proteinuria on the rate of decline of kidney function and the risk of end-stage kidney disease. They have also considered children with glomerular and, more importantly, the more common, congenital causes of CKD. Current studies have important strengths but also a few weaknesses that limit the validity of the conclusions which can be drawn. There is still a need for large clinical trials that focus primarily on studying the influence of proteinuria on kidney function and on finding remedies that delay progression.
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Affiliation(s)
- Sahar A Fathallah-Shaykh
- Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 516 Lowder Building, 1600 7th Avenue South, Birmingham, AL, 35233, USA.
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16
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Chou HH, Lin CY, Chiou YH, Tain YL, Wang YF, Wang HH, Chiou YY. Clinical characteristics and prevalence of complications of chronic kidney disease in children: the Taiwan Pediatric Renal Collaborative study. Pediatr Nephrol 2016; 31:1113-20. [PMID: 26850057 DOI: 10.1007/s00467-016-3325-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Little information is available regarding the clinical characteristics and prevalence of complications in children with chronic kidney disease (CKD), especially in early disease stages. The objective of this study was to determine the clinical characteristics and prevalence of complications in children with predialytic CKD. METHODS This multicenter, cross-sectional study enrolled children at all stages of predialytic CKD. Children who were between the ages of 1 year and 18 years and who fulfilled the clinical criteria of CKD were included in the study. Baseline demographic data, previous history, clinical characteristics, and laboratory data were collected. RESULTS A total of 757 children were included in the study. The median age at the time of enrollment was 10.6 years; 397 patients (52.4 %) were males. A total of 39.0 % of the patients were in CKD stage 1, 37.6 % were in stage 2, 14.8 % were in stage 3, 3.0 % were in stage 4, and 5.5 % were in stage 5. Nonglomerular renal diseases were the primary cause of CKD, comprising 51.9 % of the patients with CKD. The age at disease onset, gender, CKD stage distribution, and proportion of co-morbidities varied between the glomerular and nonglomerular CKD cases. Anemia, hyperlipidemia, hypocalcemia, and hyperphosphatemia were more prevalent in patients with glomerular CKD. The overall prevalence of complications was as follows: uncontrolled blood pressure, 44.1 %; anemia, 34.2 %; hyperlipidemia, 44.9 %; short stature, 10.3 %; and failure to thrive, 8.2 %. Uncontrolled blood pressure (BP), anemia, and hyperlipidemia were common, even in the early CKD stages. The prevalence of CKD complications generally increased with the worsening stage of CKD. CONCLUSIONS This study reveals differences in CKD etiology and prevalence of specific complications according to the stage of CKD. Early recognition and awareness of complications are mandatory for clinicians during the follow-up visits of children with CKD.
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Affiliation(s)
- Hsin-Hsu Chou
- Division of Pediatric Nephrology, Department of Pediatrics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Applied Life Science & Health, College of Human Ecology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ching-Yuang Lin
- Clinical Immunological Center, Medical College and Hospital, China Medical University, Taichung, Taiwan
| | - Yee-Hsuan Chiou
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - You-Lin Tain
- Division of Pediatric Nephrology, College of Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, Kaohsiung, Taiwan
| | - Yi-Fan Wang
- Division of Pediatric Nephrology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsin-Hui Wang
- Division of Pediatric Immunology and Nephrology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Pediatrics, Faculty of Medicine, School of Medicine, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yuan-Yow Chiou
- Division of Pediatric Nephrology, Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan. .,Department of Pediatrics and Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
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Dell KM, Matheson M, Hartung EA, Warady BA, Furth SL. Kidney Disease Progression in Autosomal Recessive Polycystic Kidney Disease. J Pediatr 2016; 171:196-201.e1. [PMID: 26831744 PMCID: PMC5349855 DOI: 10.1016/j.jpeds.2015.12.079] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/23/2015] [Accepted: 12/30/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To define glomerular filtration rate (GFR) decline, hypertension (HTN), and proteinuria in subjects with autosomal recessive polycystic kidney disease (ARPKD) and compare with 2 congenital kidney disease control groups in the Chronic Kidney Disease in Children cohort. STUDY DESIGN GFR decline (iohexol clearance), rates of HTN (ambulatory/casual blood pressures), antihypertensive medication usage, left ventricular hypertrophy, and proteinuria were analyzed in subjects with ARPKD (n = 22) and 2 control groups: aplastic/hypoplastic/dysplastic disorders (n = 44) and obstructive uropathies (n = 44). Differences between study groups were examined with the Wilcoxon rank sum test. RESULTS Annualized GFR change in subjects with ARPKD was -1.4 mL/min/1.73 m(2) (-6%), with greater decline in subjects age ≥ 10 years (-11.5%). However, overall rates of GFR decline did not differ significantly in subjects with ARPKD vs controls. There were no significant differences in rates of HTN or left ventricular hypertrophy, but subjects with ARPKD had a greater percent on ≥ 3 blood pressure medications (32% vs 0%, P < .0001), more angiotensin-converting enzyme inhibitor use (82% vs 27% vs 36%, P < .0005), and less proteinuria (urine protein: creatinine = 0.1 vs 0.6, P < .005). CONCLUSIONS This study reports rates of GFR decline, HTN, and proteinuria in a small but well-phenotyped ARPKD cohort. The relatively slow rate of GFR decline in subjects with ARPKD and absence of significant proteinuria suggest that these standard clinical measures may have limited utility in assessing therapeutic interventions and highlight the need for other ARPKD kidney disease progression biomarkers.
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Affiliation(s)
- Katherine M Dell
- Center for Pediatric Nephrology, Cleveland Clinic Children's, Department of Pediatrics, Case Western Reserve University, Cleveland, OH.
| | - Matthew Matheson
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD
| | - Erum A Hartung
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, MO
| | - Susan L Furth
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
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Kang HG, Choi HJ, Han KH, Kim SH, Cho HY, Cho MH, Shin JI, Lee JH, Lee J, Oh KH, Park YS, Cheong HI, Ahn C, Ha IS. KNOW-Ped CKD (KoreaN cohort study for outcomes in patients with pediatric CKD): Design and methods. BMC Nephrol 2016; 17:35. [PMID: 27012243 PMCID: PMC4807586 DOI: 10.1186/s12882-016-0248-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/18/2016] [Indexed: 12/25/2022] Open
Abstract
Background The global prevalence of chronic kidney disease (CKD) is increasing. In children, CKD exhibits unique etiologies and can have serious impacts on children’s growth and development. Therefore, an aggressive approach to preventing the progression of CKD and its complications is imperative. To improve the understanding and management of Asian pediatric patients with CKD, we designed and launched KNOW-Ped CKD (KoreaN cohort study for Outcome in patients With Pediatric Chronic Kidney Disease), a nationwide, prospective, and observational cohort study of pediatric CKD with funding from the Korean government. Methods/design From seven major centers, 450 patients <20 years of age with CKD stages I to V are recruited for the comprehensive assessment of clinical findings, structured follow-up, and bio-specimen collection. The primary endpoints include CKD progression, defined as a decline of estimated glomerular filtration rate by 50 %, and a requirement for renal replacement therapy or death. The secondary outcomes include the development of left ventricular hypertrophy or hypertension, impairment of growth, neuropsychological status, behavioral status, kidney growth, and quality of life. Discussion With this study, we expect to obtain more information on pediatric CKD, which can be translated to better management for the patients. Trial registration NCT02165878 (ClinicalTrials.gov), submitted on June 11, 2014.
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Affiliation(s)
- Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hyun Jin Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Kyung Hee Han
- Department of Pediatrics, Jeju University Hospital, Jeju, South Korea
| | - Seong Heon Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, South Korea
| | - Hee Yeon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min Hyun Cho
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital, Seoul, South Korea
| | - Joo Hoon Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joongyub Lee
- Department of Preventive Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Kook Hwan Oh
- Department of Internal Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Young Seo Park
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hae Il Cheong
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Children's Hospital, Seoul, South Korea.
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.
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Jellouli M, Boussetta A, Abidi K, Maalej B, Naija O, Hammi Y, Zarrouk C, Mahfoudh A, Gargah T. [Etiologies of end-stage renal disease of children in Tunisia]. Nephrol Ther 2016; 12:166-70. [PMID: 26906230 DOI: 10.1016/j.nephro.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/25/2015] [Accepted: 09/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The end-stage renal disease (ESRD) in children has special features in terms of etiologies, therapeutic modalities and access to renal transplantation. In Tunisia, there are no data on the epidemiology of ESRD in children. The aim of our study was to describe epidemiology of ESRD among Tunisian children. METHODS This retrospective study was conducted in pediatric departments in Charles-Nicolle Hospital, Tunis and Hedi Chaker hospital, Sfax, during a period of 15 years (1st January 1998-31st December 2013). We included children who develop ESRD before the age of 15 years. RESULTS In total, 166 patients were included. The median duration of follow-up was 48 months. We collected respectively 24 children (14.5%) aged less than 2 years, 24 children (14.5%) aged between 2 and 6 years and 118 children (71%) older than 6 years. The sex ratio was equal to 1.4. The mean incidence was 4.25 cases per million children. The main causes were represented by congenital anomalies of the kidneys and urinary tract (35.5%), hereditary renal disease (31.3%) and glomerular kidney disease (9.6%). All patients were treated in kidney transplant dialysis programs; the main mode of dialysis was represented by peritoneal dialysis, which represented the initial dialysis mode in 81% of cases. The transition to hemodialysis was noted in 43.4% cases. Thirty-eight patients (22.8%) were transplanted. The mortality rate was 27.1%. The leading cause of death was cardiovascular diseases (37.7%) and infections (22.2%). CONCLUSION The creation of a national registry of kidney disease in Tunisia is necessary for a better knowledge of needs for dialysis and renal transplantation in children.
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Affiliation(s)
- Manel Jellouli
- Service de pédiatrie, hôpital Charles-Nicolle, Tunis, Tunisie.
| | - Abir Boussetta
- Service de pédiatrie, hôpital Charles-Nicolle, Tunis, Tunisie
| | - Kamel Abidi
- Service de pédiatrie, hôpital Charles-Nicolle, Tunis, Tunisie
| | - Bayen Maalej
- Service de pédiatrie, hôpital Hédi Chaker, Sfax, Tunisie
| | - Ouns Naija
- Service de pédiatrie, hôpital Charles-Nicolle, Tunis, Tunisie
| | - Yousra Hammi
- Service de pédiatrie, hôpital Charles-Nicolle, Tunis, Tunisie
| | - Chokri Zarrouk
- Service de pédiatrie, hôpital Charles-Nicolle, Tunis, Tunisie
| | | | - Tahar Gargah
- Service de pédiatrie, hôpital Charles-Nicolle, Tunis, Tunisie
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Insignificant impact of VUR on the progression of CKD in children with CAKUT. Pediatr Nephrol 2016; 31:105-12. [PMID: 26404649 DOI: 10.1007/s00467-015-3196-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Vesicoureteral reflux (VUR) is associated with an increased risk of kidney disorders. It is unclear whether VUR is associated with progression from chronic kidney disease (CKD) to end-stage kidney disease (ESKD) in children with congenital anomalies of the kidney and urinary tract (CAKUT). METHODS We conducted a 3-year follow-up survey of a cohort of 447 children with CKD (stage 3-5). Rates of and risk factors for progression to ESKD were determined using the Kaplan-Meier method and Cox regression respectively. RESULTS Congenital anomaly of the kidney and urinary tract was the primary etiology in 278 out of 447 children; 118 (42.4 %) had a history of VUR at the start of the cohort study. There were significantly more boys than girls with VUR, whereas the proportions were similar in children without VUR. The types of urinary anomalies/complications of the two groups were significantly different. Three-year renal survival rates of the groups were not significantly different, irrespective of CKD stage. Age < 2 years and age after puberty, stage 4 or 5 CKD, and heavy proteinuria, but not history of VUR, were significantly associated with progression to ESKD. CONCLUSIONS History of VUR at the start of follow-up was not associated with the progression of stage 3-5 CKD in children with CAKUT.
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Hirano D, Ishikura K, Uemura O, Ito S, Wada N, Hattori M, Ohashi Y, Hamasaki Y, Tanaka R, Nakanishi K, Kaneko T, Honda M. Association between low birth weight and childhood-onset chronic kidney disease in Japan: a combined analysis of a nationwide survey for paediatric chronic kidney disease and the National Vital Statistics Report. Nephrol Dial Transplant 2015; 31:1895-1900. [DOI: 10.1093/ndt/gfv425] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/22/2015] [Indexed: 01/21/2023] Open
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Besbas N, Kalyoncu M, Cil O, Ozgul RK, Bakkaloglu A, Ozaltin F. MCP1 2518 A/G polymorphism affects progression of childhood focal segmental glomerulosclerosis. Ren Fail 2015; 37:1435-9. [PMID: 26335292 DOI: 10.3109/0886022x.2015.1074474] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Monocyte chemoattractant protein-1 (MCP-1) is a highly specific chemokine for monocytes and plays roles in pathogenesis of various renal diseases. The aim of this study is to investigate the effect of MCP1 2518 A/G polymorphism on the incidence and clinical course of focal segmental glomerulosclerosis (FSGS) in children. MCP1 2518 A/G genotype was identified by PCR-RFLP in 60 biopsy-proven FSGS patients, 76 steroid sensitive nephrotic syndrome (SSNS) patients, and 96 healthy children. MCP-1 levels in urine and serum were measured by ELISA in all patients and the correlations of genotype with MCP-1 levels and clinical outcome were evaluated. The genotype frequencies for MCP1 were similar in all groups. The percentage of patients who develop chronic renal failure was higher in patients with AA allele compared to GA or GG alleles (46% vs. 35% respectively, p < 0.01, Odds ratio: 1.59). Serum MCP-1 levels were similar in all groups, whereas urinary MCP-1 levels of the patients with FSGS (1680 pg/mg creatinine) were significantly higher than that of patients with SSNS (365 pg/mg creatinine, p < 0.05) and healthy controls (348 pg/mg creatinine; p < 0.05). Urinary MCP-1 levels were correlated with the degree of proteinuria in FSGS group (r = 0.529, p = 0.016). Our results suggest that the AA genotype might be a risk factor for the progression of renal disease in FSGS and MCP1 genotyping may help the physicians to predict prognosis in these patients.
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Affiliation(s)
- Nesrin Besbas
- a Department of Pediatric Nephrology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Mukaddes Kalyoncu
- b Department of Pediatric Nephrology , Karadeniz Technical University Faculty of Medicine , Trabzon , Turkey
| | - Onur Cil
- a Department of Pediatric Nephrology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Riza Koksal Ozgul
- c Department of Pediatric Metabolism , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Aysin Bakkaloglu
- a Department of Pediatric Nephrology , Hacettepe University Faculty of Medicine , Ankara , Turkey
| | - Fatih Ozaltin
- a Department of Pediatric Nephrology , Hacettepe University Faculty of Medicine , Ankara , Turkey .,d Nephrogenetics Laboratory, Department of Pediatric Nephrology , Hacettepe University Faculty of Medicine , Ankara , Turkey , and.,e Hacettepe University Center for Biobanking and Genomics , Ankara , Turkey
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Hamasaki Y, Ishikura K, Uemura O, Ito S, Wada N, Hattori M, Ohashi Y, Tanaka R, Nakanishi K, Kaneko T, Honda M. Growth impairment in children with pre-dialysis chronic kidney disease in Japan. Clin Exp Nephrol 2015; 19:1142-8. [PMID: 25715867 DOI: 10.1007/s10157-015-1098-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 02/15/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Growth impairment is a major complication of chronic kidney disease (CKD) in children. However, no cohort studies have examined the growth of Asian children with pre-dialysis CKD. METHODS We sent cross-sectional surveys to 113 Japanese medical institutions that were treating 447 children with CKD stages 3-5 in 2010 and 2011. Of 447 children included in our survey conducted in 2010, height and CKD stage were evaluable for 297 children in 2011, and height standard deviation score (height SDS) was calculated in these children. RESULTS Height SDS decreased with increasing CKD stage (P < 0.001) in boys and girls. Height SDS also decreased significantly with increasing CKD stage among patients with congenital anomalies of the kidney and urinary tract (P < 0.001). Risk factors for growth impairment included CKD stages 4 and 5 (relative to stage 3), being small-for-date, and asphyxia at birth. Among children with a height SDS ≤-2.0, growth hormone was used in 19.5, 31.0, and 25.0 % of children with CKD stages 3, 4, and 5, respectively. CONCLUSIONS This prospective cohort study revealed marked growth impairment in Japanese children with CKD stages 3-5 relative to healthy children. CKD-related risk factors for growth impairment included advanced CKD (stages 4 and 5), being small-for-date, and asphyxia at birth. Growth hormone was infrequently used in this cohort of children with pre-dialysis CKD.
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Affiliation(s)
- Yuko Hamasaki
- Department of Pediatric Nephrology, Toho University Faculty of Medicine, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Kenji Ishikura
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.,Division of Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Osamu Uemura
- Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Shuichi Ito
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Naohiro Wada
- Department of Pediatric Nephrology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuo Ohashi
- Department of Integrated Science and Technology for Sustainable Society, Chuo University, Tokyo, Japan
| | - Ryojiro Tanaka
- Department of Nephrology, Hyogo Prefectural Children's Hospital, Hyogo, Japan
| | - Koichi Nakanishi
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Tetsuji Kaneko
- Division of Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Masataka Honda
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Fathallah-Shaykh SA, Flynn JT, Pierce CB, Abraham AG, Blydt-Hansen TD, Massengill SF, Moxey-Mims MM, Warady BA, Furth SL, Wong CS. Progression of pediatric CKD of nonglomerular origin in the CKiD cohort. Clin J Am Soc Nephrol 2015; 10:571-7. [PMID: 25635034 DOI: 10.2215/cjn.07480714] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/05/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Congenital anomalies of the kidney and urinary tract and genetic disorders cause most cases of CKD in children. This study evaluated the relationships between baseline proteinuria and BP and longitudinal changes in GFR in children with these nonglomerular causes of CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Urine protein-to-creatinine ratio, casual systolic and diastolic BP (normalized for age, sex, and height), and GFR decline were assessed in the prospective CKD in Children cohort study. RESULTS A total of 522 children, median age 10 years (interquartile range, 7, 14 years) with nonglomerular CKD were followed for a median of 4.4 years. The mean baseline GFR in the cohort was 52 ml/min per 1.73 m(2) (95% confidence interval [95% CI], 50 to 54) and declined 1.3 ml/min per 1.73 m(2) per year on average (95%CI, 1.6 to 1.1). A 2-fold higher baseline urine protein-to-creatinine ratio was associated with an accelerated GFR decline of 0.3 ml/min per 1.73 m(2) per year (95% CI, 0.4 to 0.1). A 1-unit higher baseline systolic BP z-score was associated with an additional GFR decline of 0.4 ml/min per 1.73 m(2) per year (95% CI, 0.7 to 0.1). Among normotensive children, larger GFR declines were associated with larger baseline urine protein-to-creatinine ratios; eGFR declines of 0.8 and 1.8 ml/min per 1.73 m(2) per year were associated with urine protein-to-creatinine ratio <0.5 and ≥0.5 mg/mg, respectively. Among children with elevated BP, average GFR declines were evident but were not larger in children with higher levels of proteinuria. CONCLUSIONS Baseline proteinuria and systolic BP levels are independently associated with CKD progression in children with nonglomerular CKD.
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Affiliation(s)
- Sahar A Fathallah-Shaykh
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Joseph T Flynn
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Christopher B Pierce
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Alison G Abraham
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Tom D Blydt-Hansen
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Susan F Massengill
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Marva M Moxey-Mims
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Bradley A Warady
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Susan L Furth
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Craig S Wong
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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