Abstract
The aim of the present study was to analyze the progression of chronic renal failure (CRF), the effects of modification of risk factors for disease progression, and to formulate a theoretical model of CRF progression in an unselected group of children with CRF. The study was a cross-sectional, retrospective analysis of 92 patients aged 9.2±5.8 years with CRF and low-level proteinuria [glomerular filtration rate (GFR) 43±18 ml/min per 1.73 m2, proteinuria 0.57 g/day, range 0–3.9 g/day]. Inclusion criteria were an established diagnosis of CRF and completion of any surgical treatment. The etiology of CRF in the majority of patients was congenital uropathy. Sixty-nine patients observed for longer than 3 years were divided into two groups according to progression of CRF or improvement of GFR. Forty-three patients were on renoprotective therapy. Over a 3-year period GFR decreased in 39 children and improved in 30 children. There were no differences between the groups in the etiology of CRF. Patients with progression of CRF were older (P<0.08), grew faster (P<0.004), had higher blood pressure (P<0.01), and were more often proteinuric (P<0.03). Arterial hypertension in patients with progression of CRF was resistant to therapy and these patients needed more intensive treatment. Renoprotective therapy led to improvement of kidney function in 50% of patients, and resistance to renoprotective therapy was correlated with increased body mass and height. Patients who received renoprotective drugs showed stabilized kidney function (P<0.007) and decreased proteinuria (P<0.05) and blood pressure (P<0.02), despite higher basal values. In patients on renoprotective therapy in whom CRF progressed despite treatment, proteinuria was persistent in contrast to patients with improvement (P<0.02). The best model of CRF progression in the path diagram included systolic blood pressure and anthropometric parameters. In conclusion, in unselected patients with CRF of non-glomerular origin and nil-to-moderate proteinuria the main risk factors for CRF progression are rapid somatic growth, age, and blood pressure. Arterial hypertension and proteinuria, even of mild intensity, differ significantly between patients with progression of CRF and those with stable or improved renal function. Renoprotective therapy is related to significant slowing of CRF progression, but the risk factors for resistance to therapy include persistent proteinuria and somatic growth.
Similar content being viewed by others
References
Brenner BM, Lawler EV, MacKenzie H (1996) The hyperfiltration theory: a paradigm shift in nephrology. Kidney Int 49:1774–1777
Remuzzi G, Bertani T (1998) Mechanism of disease: pathophysiology of progressive nephropathies. N Engl J Med 339:1448–1456
Ruggenenti P, Perna A, Mosconi A, Pisoni R, Remuzzi G, The Gruppo Italiano Di Studi Epidemiologici in Nefrologia (GISEN) (1998) Urinary protein excretion rate is the best independent predictor of ESRF in non-diabetic proteinuric chronic nephropathies. Kidney Int 53:1209–1216
GISEN Group (1997) Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 349:1857–1863
Ardissino G (2002) Epidemiology of chronic renal failure. In: Cochat P (ed) ESPN Handbook, 1st edn, ESPN, pp 369–371
Ardissino G, Dacco V, Testa S, Vigano S, Loi S, Paglialonga F, Claris-Apiani A on behalf of the ItalKid (2002) Puberty triggers progression of CRF in children (abstract). Pediatr Nephrol 17:C47
Dalton RN, Haycock GB (1999) Laboratory investigation. In: Barratt TM, Avner ED, Harmon WE (eds) Pediatric nephrology, 4th edn. Lippincot Williams Wilkins , p 355
A Working Group Report from the National High Blood Pressure Education Program (1996) Update on the 1987 Task Force on High Blood Pressure in Children and Adolescents. Pediatrics 98:649–657
Wingen AM, Fabian-Bach C, Schaefer F, Mehls O (1997) Randomised multicentre study of a low protein diet on the progression of chronic renal failure in children. Lancet 349:1117–1123
Fivush AB, Jabs K, Neu AM, Sullivan FK, Feld L, Kohaut E, Fine R (1998) Chronic renal insufficiency in children and adolescents: the 1996 annual report of NAPRTCS. Pediatr Nephrol 12:328–337
Litwin M, Grenda R, Prokurat S, Abuauba M, Latoszynska J, Jobs K, Wawer ZT (2001) Survival and causes of death among children on hemodialysis and peritoneal dialysis. Pediatr Nephrol 16:996–1001
Wassner SJ, Baum M (1999) Chronic renal failure—epidemiology. In: Barratt TM, Avner ED, Harmon WE (eds) Pediatric nephrology, 4th edn. Lippincot Williams Wilkins, p 1158
Kambham N, Markowitz GS, Valeri AM, Lin J, D’Agati VD (2001) Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 59:1498–1509
Bounet F, Deprele C, Sassolas A, Moulin P, Alamartine E, Berthezene F, Berthoux F (2001) Body weight as new independent risk factor for clinical and pathological progression in primary IgA nephritis. Am J Kidney Dis 37:720–724
Soares CMB, Oliveira EA, Diniz JSS, Lima EM, Vasconcelos MM, Oliveira GR (2003) Predictive factors of progression of chronic renal insufficiency: a multivariate analysis. Pediatr Nephrol 18:371–377
Ruggenenti P, Perna A, Remuzzi G on behalf of The Investigators of the GISEN Group (2003) Retarding progression of chronic renal disease: the neglected issue of residual proteinuria. Kidney Int 63:2254–2261
Ruggenenti P, Schiepatti A, Remuzzi G (2001) Progression, remission, regression of chronic renal diseases. Lancet 357:1601–1608
Ruggenenti P, Brenner B, Remuzzi G (2001) Remission achieved in chronic nephropathy by a multidrug approach targeted at urinary protein excretion. Nephron 88:254–259
Żurowska A, Bałasz I, Zagożdżon I, Marczak E (2000) Arterial hypertension in children with chronic renal failure Pol Merk Lek 46:259–260
Ruggenenti P, Perna A, Lesti M, Pisoni R, Mosconi L, Arnoldi F, Ciocca I, Gaspari F, Remuzzi G (2000) Pretreatment blood pressure reliably predicts progression of chronic nephropathies. Kidney Int 58:2093–2101
Ruggenenti P, Perna A, Zoccali C, Gherardi G, Benini R, Testa A, Remuzzi G and the “Gruppo Italiano Di Studi Epidemiologici in Nefrologia” (2000) Chronic proteinuric nephropathies. II. Outcomes and response to treatment in a prospective cohort of 352 patients: differences between women and men in relation to the ACE gene polymorphism. J Am Soc Nephrol 11:88–96
Remuzzi G, Ruggenenti P, Perico N (2002) Chronic renal disease protection benefits of renin-angiotensin system inhibition. Ann Intern Med 136:604–615
Lama G, Salsano ME, Pedulla M, Grascia C, Ruocco C (1997) Angiotensin converting enzyme inhibition and reflux nephropathy: 2 year follow-up. Pediatr Nephrol 11:714–718
Locatelli F, Del Vecchio L, Pozzoni P (2002) The importance of early detection of chronic kidney disease. Nephrol Dial Transplant 17 [Suppl 11]:2–7
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Litwin, M. Risk factors for renal failure in children with non-glomerular nephropathies. Pediatr Nephrol 19, 178–186 (2004). https://doi.org/10.1007/s00467-003-1329-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-003-1329-4