Renal agenesis and dysgenesis: are they increasing?
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N E Stroup1, L Edmonds, T R O'Brien
1Division of Chronic Disease Control & Community Intervention, Centers for Disease Control, Atlanta, Georgia 30333.
Insights
Birth defects data indicate a rising prevalence of renal agenesis and dysgenesis. The increase is primarily driven by renal dysgenesis, necessitating further research into maternal risk factors.
Area of Science:
- Pediatric Nephrology
- Birth Defect Epidemiology
- Public Health Surveillance
Background:
- The Birth Defects Monitoring Program (BDMP) of the Centers for Disease Control (CDC) has observed an increasing trend in the combined birth prevalence of renal agenesis and dysgenesis.
- It remains unclear whether this trend reflects a true increase in these conditions or changes in diagnostic, coding, or surveillance practices.
Purpose of the Study:
- To investigate the observed increase in the birth prevalence of renal agenesis and dysgenesis.
- To determine the specific contributions of renal agenesis versus renal dysgenesis to the overall trend.
- To identify potential factors influencing the observed changes over time.
Main Methods:
- Review of medical records for 1,404 infants (84% of identified cases) within the BDMP diagnosed with renal agenesis or dysgenesis.
- Analysis of autopsy-confirmed cases of bilateral renal agenesis and dysgenesis from 1970-1982.
- Assessment of diagnostic information and detection methods (autopsy vs. other procedures).
Main Results:
- The combined birth prevalence of renal agenesis and dysgenesis appears to be increasing.
- Autopsy-confirmed bilateral renal agenesis rates fluctuated, while bilateral renal dysgenesis showed a steady annual increase of 0.2 cases per 100,000 births (P < 0.001).
- Unilateral cases constituted 17% and were primarily detected via autopsy.
Conclusions:
- The observed increase in combined renal agenesis and dysgenesis is primarily attributed to a rising prevalence of renal dysgenesis.
- Further analytical studies are required to identify potential maternal risk factors associated with the increasing incidence of renal dysgenesis.
Abstract:
Data from the Birth Defects Monitoring Program (BDMP) of the Centers for Disease Control (CDC) suggest that the birth prevalence of renal agenesis and dysgenesis combined is increasing. Medical records were reviewed for 1,404 of 1,669 (84%) infants in the BDMP with renal agenesis or dysgenesis noted on the newborn discharge summary to assess whether the observed trend reflects a true increase in one or both conditions or if it reflects changes in diagnostic, coding, or surveillance practices over time. For 1970-1982, the average rate per 100,000 live births and stillbirths was 3.5 for autopsy-confirmed bilateral renal agenesis and 1.7 for autopsy-confirmed bilateral renal dysgenesis. The birth prevalence of autopsy-confirmed bilateral renal agenesis fluctuated within this time period, peaking in 1975, while the rate of autopsy-confirmed bilateral renal dysgenesis increased steadily by 0.2 cases/100,000 births per year (P less than 0.001) with small peaks in 1976 and 1979. Unilateral renal agenesis or dysgenesis accounted for 17% of the confirmed cases, but most were detected by autopsy among infants who died shortly after birth rather than by diagnostic procedures such as ultrasound. Diagnostic information in the medical record suggested that the increase in the birth prevalence of renal agenesis and dysgenesis combined in the BDMF is due primary to the increasing prevalence of renal dysgenesis. Since medical records did not include sufficient information on risk factors, detailed analytic studies are needed to identify maternal risk factors that might account for the apparent increase in renal dysgenesis over time.