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A clinical predictive model of renal injury in children with congenital solitary functioning kidney

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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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Funding

R.H.M. is supported by NIH grants U01 DK-03012 and R24HD050837. E.A.O. is supported by CAPES grant 2746-15-8. This study was partially supported by CNPq (Brazilian National Research Council, Grant 481649/2013-1), FAPEMIG (Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Grant PPM-00228-15), and the INCT-MM Grant (FAPEMIG: CBBAPQ-00075-09/CNPq 573646/2008-2).

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Authors and Affiliations

  1. 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

    Isabel V. Poggiali, Ana Cristina Simões e Silva, Mariana A. Vasconcelos, Cristiane S. Dias, Izabella R. Gomes, Rafaela A. Carvalho, Maria Christina L. Oliveira, Sergio V. Pinheiro & Eduardo A. Oliveira

  2. Division of Pediatric Nephrology, Rady Children’s Hospital San Diego, University of California, San Diego, La Jolla, CA, USA

    Robert H. Mak & Eduardo A. Oliveira

Authors
  1. Isabel V. Poggiali
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  2. Ana Cristina Simões e Silva
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  3. Mariana A. Vasconcelos
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  4. Cristiane S. Dias
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  7. Maria Christina L. Oliveira
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  8. Sergio V. Pinheiro
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Corresponding author

Correspondence to Eduardo A. Oliveira.

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The Ethics Committee of the Federal University of Minas Gerais approved the study, and the parents or individuals responsible for the children gave written informed consent to participate.

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The authors declare that they have no conflict of interest.

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Poggiali, I.V., Simões e Silva, A.C., Vasconcelos, M.A. et al. A clinical predictive model of renal injury in children with congenital solitary functioning kidney. Pediatr Nephrol 34, 465–474 (2019). https://doi.org/10.1007/s00467-018-4111-3

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