Kenji Ishikura1,2, Osamu Uemura3,4, Yuko Hamasaki5, Hideo Nakai6, Shuichi Ito7, Ryoko Harada8, Motoshi Hattori9, Yasuo Ohashi10, Ryojiro Tanaka11, Koichi Nakanishi12, Tetsuji Kaneko13, Kazumoto Iijima8, Masataka Honda8. 1. Department of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. kenzo@ii.e-mansion.com. 2. Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. kenzo@ii.e-mansion.com. 3. Department of Pediatric Nephrology, Aichi Children's Health and Medical Center, Aichi, Japan. 4. Department of Clinical Medicine, Japanese Red Cross Toyota College of Nursing, Aichi, Japan. 5. Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan. 6. Department of Pediatric Urology, Jichi Medical University, Children's Medical Center, Tochigi, Japan. 7. Department of Pediatrics, Yokohama City University Graduate School of Medicine, Kanagawa, Japan. 8. Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan. 9. Department of Pediatric Nephrology, Tokyo Women's Medical University, Tokyo, Japan. 10. Department of Integrated Science and Engineering for Sustainable Society, Faculty of Science and Engineering, Chuo University, Tokyo, Japan. 11. Department of Nephrology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan. 12. Department of Pediatrics, Wakayama Medical University, Wakayama, Japan. 13. Division of Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
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.
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.
Entities:
Keywords:
Chronic kidney disease; Cohort study; Congenital anomalies of the kidney and urinary tract; End-stage kidney disease; Vesicoureteral reflux
Authors: Craig A Peters; Steven J Skoog; Billy S Arant; Hillary L Copp; Jack S Elder; R Guy Hudson; Antoine E Khoury; Armando J Lorenzo; Hans G Pohl; Ellen Shapiro; Warren T Snodgrass; Mireya Diaz Journal: J Urol Date: 2010-07-21 Impact factor: 7.450