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Proteinuria as a predictor of disease progression in children with hypodysplastic nephropathy

Data from the ItalKid Project

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Abstract

Little is known about the role of proteinuria in the progression of childhood renal diseases. We analyzed the decline in creatinine clearance (C Cr) and kidney survival in 225 children (185 males) with chronic renal failure (CRF) due to isolated hypodysplasia or hypodysplasia associated with urological abnormalities. The data were based on the information available in the Italian Pediatric Registry of CRF (ItalKid Project), which includes patients from all of Italy aged <20 years with C Cr levels of <75 ml/min per 1.73 m2. Patients aged <2 years and those with C Cr levels of <20 ml/min per 1.73 m2 or a follow-up of <1 year were excluded from the analysis, as were those receiving angiotensin-converting enzyme inhibitors. At baseline, the patients had a mean age of 7.8±4.2 years, a mean C Cr of 50±16.3 ml/min per 1.73 m2, a median urinary protein/urinary creatinine (uPr/uCr) ratio of 0.38 (range 0.02–7.21), and a mean duration of follow-up of 3.5±1.1 years. The patients were divided into three groups on the basis of their baseline proteinuria levels: group A normal (uPr/uCr <0.2) n=83; group B low (uPr/uCr 0.2–0.9) n=71; and group C mild (uPr/uCr >0.9) n=71. Patients in groups A and B showed a significantly slower decline in C Cr than those in group C (slope +0.16±3.64 and −0.54±3.67 vs. −3.61±5.47, P<0.0001) and a higher rate of kidney survival after 5 years (96.7% and 94.1% vs. 44.9%, P<0.01). By multivariate analysis, the baseline uPr/uCr ratio (P<0.01) and age (P<0.0001) correlated with a faster decline in C Cr irrespective of baseline C Cr. There was no correlation with mean arterial blood pressure. We conclude that proteinuria is an independent predictor of progression to end-stage renal failure also in children whose renal impairment is due to congenital hypodysplasia.

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Acknowledgements

The ItalKid project is supported by a research grant from the “Associazione per il Bambino Nefropatico”. We would like to thank the following for their valuable cooperation: Ms. S. Loi (Secretary of the ItalKid Project) for data management, Dr. C.A. Ferrero (Istituto Scientifico H.S. Raffaele, Laboratorio Standardizzazione) for the laboratory quality control program, Mr. P. Marchetto for computer assistance, and Mr. K. Smart (Link Srl) for his linguistic help in the preparation of the manuscript.

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Authors and Affiliations

  1. Unit of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, Clinica Pediatrica De Marchi, Via Commenda 9, 20122, Milan, Italy

    Gianluigi Ardissino, Sara Viganò & Mirella Procaccio

  2. Department of Pediatrics, Clinica Pediatrica De Marchi, Milan, Italy

    Sara Testa, Valeria Daccò & Aldo Claris-Appiani

  3. Epidemiology Unit, IRCCS Ospedale Maggiore, Milan, Italy

    Emanuela Taioli

  4. Division of Pediatric Surgery, IRCCS Policlinico S. Matteo, Pavia, Italy

    Luigi Avolio

  5. Division of Nephrology, Ospedale Civile “S. Spirito”, Pescara, Italy

    Antonio Ciofani

  6. Division of Pediatric Nephrology, Ospedale Pediatrico “Bambino Gesù”, Rome, Italy

    Luca Dello Strologo

  7. Unit of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, Ospedale Civile, Padua, Italy

    Giovanni Montini

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  1. Gianluigi Ardissino
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  2. Sara Testa
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Corresponding author

Correspondence to Gianluigi Ardissino.

Additional information

This paper was written on behalf of all the members of the ItalKid Project whose contribution has been essential. Members of the ItalKid Project:

G. Aceto (Bari), G. Airoldi (Borgomanero), G. Amici (Ancona), A. Ammenti (Parma), B. Andretta (Padova), G. Ardissino (Milano), F. Ardito (Bologna), B. Assael (Verona), L. Avolio (Pavia), S. Bassi (Montichiari), F. Battaglino (Vicenza), R. Bellantuono (Bari), A. Bettinelli (Merate), C. Bigi (Lecco), S. Binda (Varese), C. Bini (Como), D. Bissi (Gallarate), R. Boero (Torino), R. Bonaudo (Torino), A. Bordugo (Pordenone), M. Borzani (Milano), M. Bosio (Milano), A. Bottelli (Varese), G. Bovio (Pavia), A. Bracone (Bra), G. Capasso (Napoli), M. Capizzi (Milano), D. Caringella (Bari), I. Carnera (Siracusa), M.R. Caruso (Bergamo), D. Cattarelli (Brescia), V. Cecchetti (Milano), M. Cecconi (Ancona), V. Cecinati (Bari), A. Ciofani (Pescara), A. Claris-Appiani (Milano), R. Coppo (Torino), F. Corona (Milano), A. Corsini (Bentivoglio), R. Costanzo (Ragusa), P. Cussino (Savigliano), M. D’Agostino (Bergamo), V. Daccò (Milano), G. Daidone (Siracusa), R. Dall’Amico (Thiene), L. Dardanelli (Cuneo), R. De Castro (Bologna), V. De Cristofaro (Sondrio), M. De Gennaro (Roma), S. De Pascale (Bergamo), N. De Santo (Napoli), D. Delfino (R. Calabria), C.A. Dell’Agnola (Milano), L. Dello Strologo (Roma), L. Dertenois (Genova), A. Dessanti (Sassari), A. Di Benedetto (Catania), A. Di Leone (Cosenza), F. Di Lorenzo (Bologna), P. Di Turi (Bologna), A. Edefonti (Milano), W. Erckert (Silandro), A. Fabris (Verona), V. Fanos (Verona), C. Fede (Messina), A. Fella (Napoli), R. Ferraro (Scorrano), M.T. Ferrazzano (Anzio), R. Ferré (Breno), A. Ferretti (Napoli), B. Fogazzi (Brescia), P. Formentin (Cittadella), C. Fortini (Ferrara), E. Fossali (Milano), G. Fossati Bellani (Milano), M. Gaido (Torino), R. Galato (Milano), G. Gargano (Modena), V. Georgacopulo (Ferrara), L. Ghio (Milano), R. Giachino (Ivrea), M. Giani (Milano), S. Gianni (Siracusa), B. Gianoglio (Torino), M. Girodano (Bari), V. Goj (Milano), F. Grancini (Milano), G. Grott (Chieri), S. Guez (Milano), R. Gusmano (Genova), A. Iovino (Napoli), C. Isimbaldi (Lecco), A. La Manna (Napoli), G. Lama (Napoli), R. Landoni (Cinisello B.), S. Li Volti (Catania), A. Liardo (Caltagirone), V. Lotti (Cesena), R. Lubrano (Roma), I. Luongo (Napoli), E. Mancini (Bologna), N. Manganaro (Messina), M. Marangella (Torino), C. Marchesoni (Trento), K. Marenzi (Segrate), S. Maringhini (Palermo), G. Marra (Milano), E. Marras (Torino), V. Mei (Bologna), F. Menni (Milano), N. Miglietti (Brescia), R. Mignani (Rimini), P. Minelli (Bologna), R. Moioli (Milano), P. Molinari (Bologna), G. Montini (Padova), M. Montis (Cagliari), G. Mosiello (Roma), L. Murer (Padova), G. Nebbia (Milano), M. Neunhauserer (Brunico), P. Nitsch (Parma), M. Noto (Palermo), C. Oppezzo (Milano), F. Paolillo (Lodi), T. Papalia (Cosenza), R. Parini (Milano), L. Parola (Magenta), F. Passione (Foggia), L. Pavanello (CastelfrancoV.), C. Pecoraro (Napoli), M. Pedron (Bolzano), I. Pela (Firenze), A. Pellegatta (Busto Arsizio), P. Pelliccia (Chieti), M. Pennesi (Trieste), C. Pennetta (Manduria), R. Penza (Bari), L. Peratoner (Pordenone), F. Perfumo (Genova), G. Perino (Torino), C. Pesce (Vicenza), L. Pisanello (Padova), M. Pitter (Mirano), L. Pontesilli (Roma), M. Porcellini (Torino), A. Pota (Napoli), R. Prandini (Bologna), F. Puteo (Bari), I. Ratsch (Ancona), E. Ravaioli (Rimini), G. Remuzzi (Bergamo), G. Riccipetitoni (Cosenza), G. Ripanti (Pesaro), G. Rizzoni (Roma), N. Roberto (Milano), A. Rosini (Ancona), M. Rossi Doria (Bologna), S. Rota (Bergamo), M. Ruzza (Milano), D. Scorrano (Belluno), A. Selicorni (Milano), G. Selvaggio (Milano), F. Sereni (Milano), O. Sernia (Savigliano), C. Setzu (Cagliari), C. Sforzini (Milano), L. Stallone (S. Giovanni Rotondo), M. Tagliaferri (Treviglio), L. Tampieri (Lugo), A. Testagrossa (Messina), A. Turrisi (Trapani), G. Vallini (Cinisello Balsamo), E. Verrina (Genova), S. Viola (Pavia), G. Visconti (Palermo), A. Voghenzi (Ferrara), G. Zacchello (Padova)

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Ardissino, G., Testa, S., Daccò, V. et al. Proteinuria as a predictor of disease progression in children with hypodysplastic nephropathy. Pediatr Nephrol 19, 172–177 (2004). https://doi.org/10.1007/s00467-003-1268-0

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  • DOI: https://doi.org/10.1007/s00467-003-1268-0

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