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Common clinical markers predict end-stage renal disease in children with obstructive uropathy
Daryl J McLeod1,2, Christina B Ching3,4, Yuri V Sebastião5
1Section of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA. Daryl.mcleod@nationwidechildrens.org.
Insights
Obstructive uropathy in children with mild-to-moderate chronic kidney disease can be predicted to progress to end-stage renal disease using readily available clinical markers. Early identification aids in managing pediatric kidney disease progression.
Area of Science:
- Pediatric Nephrology
- Urology
- Chronic Kidney Disease Research
Background:
- Obstructive uropathy (OU) is a significant cause of end-stage renal disease (ESRD) in the pediatric population.
- Children with mild-to-moderate chronic kidney disease (CKD) secondary to OU face ongoing risks for disease progression.
- Predictive capabilities of standard clinical markers for OU-related CKD progression in children are not well-defined.
Purpose of the Study:
- To evaluate the predictive value of baseline and longitudinal clinical markers for the progression to ESRD in children with OU and mild-to-moderate CKD.
- To identify key indicators that signify a higher risk of renal replacement therapy (RRT) in this cohort.
Main Methods:
- A cohort of patients with obstructive uropathy was identified within the Chronic Kidney Disease in Children Study.
- Cases were defined as patients requiring renal replacement therapy (RRT), while age-matched controls did not require RRT during follow-up.
- Analysis included comparison of baseline and longitudinal data for glomerular filtration rate (GFR), urine protein/creatinine, microalbumin/creatinine, serum CO2, hemoglobin, phosphate, and albumin.
Main Results:
- Significant differences were observed between cases and controls in baseline GFR, urine protein/creatinine, microalbumin/creatinine, serum CO2, and hemoglobin.
- Cases exhibited a faster annual decline in GFR (3.07 mL/min/1.73 m²/year) compared to controls.
- Cases also showed a greater annual increase in urine protein/creatinine and microalbumin/creatinine, and a greater annual increase in serum phosphate and decrease in hemoglobin and albumin.
Conclusions:
- Readily available clinical measures, assessed at baseline and longitudinally, can predict the progression to ESRD in children with mild-to-moderate CKD from obstructive uropathy.
- These findings highlight the importance of monitoring specific biomarkers for risk stratification and timely intervention in pediatric patients with OU.
Background:
Obstructive uropathy (OU) is a common cause of end-stage renal disease (ESRD) in children. Children who escape the newborn period with mild-to-moderate chronic kidney disease (CKD) continue to be at increased risk. The predictive ability of clinically available markers throughout childhood is poorly defined.
Methods:
Patients with OU were identified in the Chronic Kidney Disease in Children Study. The primary outcome of interest was renal replacement therapy (RRT) (cases). Controls were age matched and defined as patients within the OU cohort who did not require RRT during study follow-up.
Results:
In total, 27 cases and 41 age-matched controls were identified. Median age at baseline and age at outcome measurement were 10 vs. 16 years, respectively. First available glomerular filtration rate (GFR) (36.9 vs. 53.5 mL/min per 1.73 m2), urine protein/creatinine (Cr) (0.40 vs. 0.22 mg/mg) and microalbumin/Cr (0.58 vs. 0.03 mg/mg), and serum CO2 (20 vs. 22 mmol/L) and hemoglobin (12.4 vs. 13.2 g/dL) differed significantly between cases and controls, respectively. GFR declined 3.07 mL/min per 1.73 m2/year faster in cases compared to that in controls (p < 0.0001). Urine protein/Cr and microalbumin/Cr increased by 0.16 and 0.11 per year more in cases compared to those in controls, respectively (p ≤ 0.001 for both). Serum phosphate increased by 0.11 mg/dL and serum albumin and hemoglobin decreased by 0.04 (g/dL) and 0.14 (g/dL) per year more for cases compared to those for controls, respectively (p < 0.05 for all).
Conclusions:
Age-specific baseline and longitudinal measures of readily available clinical measures predict progression to ESRD in children with mild-to-moderate CKD from OU.
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