Nadir Creatinine in Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Single-Center Experience
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Marius-Cosmin Colceriu1,2, Paul Luchian Aldea3, Bogdan Bulată4
1Discipline of Physiology, Department of Functional Biosciences, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
Insights
Nadir creatinine levels in children with congenital anomalies of the kidney and urinary tract (CAKUT) can predict progression to end-stage renal disease (ESRD). A threshold of 0.98 mg/dL effectively identifies at-risk patients.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Diagnostics
Background:
- Congenital anomalies of the kidney and urinary tract (CAKUT) are the primary cause of chronic kidney disease (CKD) in children.
- CAKUT accounts for 50-70% of pediatric end-stage renal disease (ESRD) cases requiring renal replacement therapy (RRT).
- Identifying prognostic factors is crucial for managing CAKUT patients and guiding therapeutic interventions.
Purpose of the Study:
- To evaluate the natural progression of antenatally diagnosed renal malformations in children.
- To identify key prognostic indicators for CAKUT patient management.
- To assess the predictive value of nadir creatinine for ESRD development.
Main Methods:
- Retrospective analysis of 205 children diagnosed with CAKUT.
- Determination of nadir serum creatinine levels within the first year of life for each patient.
- Utilized Receiver Operating Characteristic (ROC) curve analysis to establish a predictive threshold for ESRD.
Main Results:
- 17.6% of patients (36/205) exhibited impaired renal function.
- 3.9% of patients (8/205) progressed to ESRD.
- A nadir creatinine cutoff of 0.98 mg/dL demonstrated high sensitivity and specificity (AUC 0.95) for predicting ESRD progression.
Conclusions:
- Nadir creatinine is a valuable prognostic marker for predicting ESRD in children with CAKUT.
- The established cutoff of 0.98 mg/dL can aid in early identification of high-risk individuals.
- Findings align with existing literature on creatinine's predictive role in pediatric kidney disease.
Background/Objectives:
Congenital anomalies of the kidney and urinary tract (CAKUT) are the main cause of chronic kidney disease (CKD) requiring renal replacement therapy (RRT) in children, being the leading cause (50-70%) of end-stage renal disease (ESRD) in children and young adults. Our study aimed to assess the natural evolution of various antenatally diagnosed renal malformations and to identify potential prognostic factors to guide the therapeutic management of patients with CAKUT.
Methods:
We conducted a retrospective study on 205 children with CAKUT. For each patient, analyzing their medical records, we established the nadir value of serum creatinine, defined as the lowest creatinine level during the first year of life. We assessed the value of nadir creatinine as a prognostic marker in patients with CAKUT, and using an ROC curve, we also determined a threshold value of nadir creatinine that predicted progression to ESRD.
Results:
The male-to-female ratio was 2.8 to 1. The mean gestational age at detection was 29.85 weeks (±6.71). A total of 36 patients (17.6%) had impaired renal function, of which 8 (3.9% of the total) progressed to ESRD. The mean nadir creatinine in patients with ESRD was 1.39 mg/dL. A nadir creatinine cut-off of 0.98 mg/dL had high sensitivity and specificity in identifying patients with progression to ESRD, with an AUC of 0.95 and a 95% confidence interval between 0.86 and 1.05 mg/dL.
Conclusions:
Our results support the value of nadir creatinine in predicting progression to ESRD, consistent with previously published data.
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