Abstract
The aim of this study is to describe progression of chronic renal failure (CRF) in children with renal malformations and to study factors influencing this progression. We reviewed retrospectively 176 children with CRF secondary to renal dysplasia, reflux nephropathy or renal obstruction with at least 5 years of follow-up. Serum creatinine was recorded at least every third month, and an estimated glomerular filtration rate (eGFR) was calculated. Number of febrile urinary tract infections (UTI), blood pressure, albuminuria (UaUc), and number of functioning kidneys was also recorded. We found that the development of renal function could be separated into three time periods: (1) During the first years of life, 82% of the children showed early improvement of their kidney function, which lasted until a median age of 3.2 years (median improvement 6.3 ml/year). (2) From the age of 3.2 years until 11.4 years, 52.5% of the studied children showed a stable kidney function, whereas in 47.5%, kidney function immediately started to deteriorate. (3) Around puberty, 42.9% started deterioration in kidney function, whereas 57.1% even after puberty showed a stable function. Patients with UaUc >200 mg/mmol deteriorated faster (−6.5 ml/min per 1.73 m2 per year compared with −1.5 ml/min per 1.73 m2 per year) in those with UaUc <50 mg/mmol. Children with more than two febrile UTIs, hypertension or an eGFR at onset of less than 40 ml/min per 1.73 m2 deteriorated faster than the others. Most children experienced early improvement of kidney function. The further prognosis, early or late deterioration of kidney function or stable function during the whole follow-up, was related to albuminuria, number of febrile UTIs, eGFR at onset of deterioration, hypertension and puberty.
Similar content being viewed by others
References
Foreman JW, Chan JCM (1988) Chronic renal failure in infants and children. J Pediatr 113:793–800
Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, Marra G, Edefonti A, Sereni F, Italkid project (2003) Epidemiology of chronic renal failure in children: data from the Italkid Project. Pediatrics 111:e382–e387
Aperia A, Broberger O, Thodenius K, Zetterstrom R (1975) Development of renal control of salt and fluid homeostasis during the first year of life. Acta Paediatr Scand 64:393–398
Jungers P, Hannedouche T, Itakura Y, Albouze Y, Descamps-Latscha B, Man NK (1995) Progression rate to end stage renal failure in non diabetic kidney disease: a multivariate analysis of determinant factors. Nephrol Dial Transplant 10:1353–1360
Lea J, Greene T, Hebert L, Lipkowitz M, Massry S, Middleton J, Rostand SG, Miller E, Smith W, Bakris GL (2005) The relationship betwen magnitude of proteinuria reduction and risk of end stage renal disease. Arch Intern Med 165:947–953
Wingen AM, Fabian-Bach C, Schaefer F, Mehls O (1997) Randomised multicentre study of low protein diet on progression of chronic renal failure in children. European study group of nutritional treatment of chronic renal failure in childhood. Lancet 349:1117–1123
Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263
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
Ardissino G, Testa S, Daccò V, Viganó S, Taioli E, Claris-Appiani A, Procaccio M, Avolio L, Ciofani A, Dello Strologo L, Montini G (2004) Proteinuria as a predictor of disease progression in children with hypodysplastic nephropathy. Pediatr Nephrol 19:172–177
Litwin M (2004) Risk factors for renal failure in children with non-glomerular nephropathies. Pediatr Nephrol 19:178–186
Ruggenenti P, Perna A, Benini R, Bertani T, Zoccali C, Maggiore Q, Salvadori M, Remuzzi G (1999) In chronic nephropathies prolonged ACE inhibition can induce remission: dynamic of time dependent changes in GFR. Investigators of the GISEN group. J Am Soc Nephrol 10:997–1006
Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G (1998) Renal function and requirement for dialysis in chronic nephropathy patients: REIN follow up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril efficacy in nephropathy. Lancet 352:1252–1256
Soergel M, Schaefer F (2002) Effect of hypertension on the progression of chronic renal failure in children. Am J Hypertens 15:53S–56S
Ljutic D, Kes P (2003) The role of arterial hypertension in the progression of non-diabetic glomerular diseases. Nephrol Dial Transplant 18(Suppl 5):v28–v30
Flack JM, Peters R, Shafi T, Alrefal H, Nasser SA, Errol C (2003) Prevention of hypertension and its complications: theoretical basis and guidelines for treatment. J Am Soc Nephrol 14:S92–S98
Parving HH, Rommel E, Schmidt UM (1998) Protection of kidney function and decrease in albuminuria by captopril in insulin dependent diabetics, with nephropathy. Br Med J 297:1089–1091
Ravid M, Lang R, Rachmani R, Lishner M (1996) Long term renoprotective effect of angiotensin converting enzyme inhibition in non-insulin dependent diabetes mellitus. A 7-year follow up study. Arch Int Med 156:239–240
Ravid M, Brosh D, Levi Z, Bar-Davan Y, Ravid D, Rachmani R (1998) Use of enalapril to attenuate decline in renal function in normotensive, normoalbuminuric patients with type 2 diabetes mellitus. A randomized controlled trial. Ann Int Med 128:982–988
Cook J, Daneman D, Spino M, Sochett E, Perlman K, Balfe JW (1990) Angiotensin-converting enzyme inhibitor therapy to decrease microalbuminuria in normotensive children with insulin-dependent diabetes mellitus. J Pediatr 117:39–45
Millner DS, Morgenstern BZ (1998) Angiotensin converting enzyme inhibitors for reduction of proteinuria in children with steroids resistant nephrotic syndrome. Pediatr Nephrol 5:587–590
Proesmans W, Van Wambecke I, Van Dyck M (1996) Long term therapy with enalapril in patients with nephrotic-range proteinuria. Pediatr Nephrol 10:587–589
Delucchi A, Cano F, Rodriguez E, Wolff E, Gonzalez X, Cumsille MA (2000) Enalapril and prednisone in children with nephrotic range proteinuria. Pediatr Nephrol 14:1088–1091
Baga A, Mudigindar BD, Hari P, Vasudev V (2004) Enalapril dosage in steroid-resistant nephrotic syndrome. Pediatr Nephrol 19:45–50
Van Dyck M, Proesmans W (2004) Renoprotection by ACE inhibitors after severe hemolytic uremic syndrome. Pediatr Nephrol 19:271–275
Lama G, Salsano ME, Pedulla M, Grassia C, Ruoco G (1997) Angiotensin converting enzyme inhibitors and reflux nephropathy: 2 years follow up. Pediatr Nephrol 11:714–718
Wühl E, Mehls O, Schaefer F, ESCAPE trial group (2004) Antihypertensive and antiproteinuric efficacy of ramipril in child with chronic renal failure. Kidney Int 66:768–776
Neild GH, Thomson G, Nitsch D, Woolfson RG, Connolly JO, Woodhouse CRJ (2004) Renal outcome in adults with renal insufficiency and irregular asymmetric kidneys. BMC Nephrol 5:12
Acknowledgements
We would like to thank Peter Miller from the Chemical Pathology Laboratory for his invaluable help in retrieving laboratory data from our patients.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
González Celedón, C., Bitsori, M. & Tullus, K. Progression of chronic renal failure in children with dysplastic kidneys. Pediatr Nephrol 22, 1014–1020 (2007). https://doi.org/10.1007/s00467-007-0459-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-007-0459-5