Early predictive factors for progression to kidney failure in infants with severe congenital anomalies of the kidney and urinary tract

被引：8

作者：

Nishi, Kentaro ^{[1
]}

Uemura, Osamu ^{[2
]}

Harada, Ryoko ^{[3
]}

Yamamoto, Masaki ^{[4
]}

Okuda, Yusuke ^{[5
]}

Miura, Kenichiro ^{[6
]}

Gotoh, Yoshimitsu ^{[7
]}

Kise, Tomoo ^{[8
]}

Hirano, Daishi ^{[9
]}

Hamasaki, Yuko ^{[10
]}

Fujita, Naoya ^{[11
]}

Uchimura, Toru ^{[12
]}

Ninchoji, Takeshi ^{[13
]}

Isayama, Tetsuya ^{[14
]}

Hamada, Riku ^{[3
]}

Kamei, Koichi ^{[1
]}

Kaneko, Tetsuji ^{[15
,16
]}

Ishikura, Kenji ^{[5
]}

机构：

[1] Natl Ctr Child Hlth & Dev, Div Nephrol & Rheumatol, Tokyo, Japan

[2] Ichinomiya Med Treatment & Habilitat Ctr, Ichinomiya, Aichi, Japan

[3] Tokyo Metropolitan Childrens Med Ctr, Dept Nephrol & Rheumatol, Tokyo, Japan

[4] Seirei Hamamatsu Gen Hosp, Dept Pediat, Shizuoka, Japan

[5] Kitasato Univ, Dept Pediat, Sch Med, 1 15 1 Kitazato,Minami ku, Sagamihara, Kanagawa 2520374, Japan

[6] Tokyo Womens Med Univ, Dept Pediat Nephrol, Tokyo, Japan

[7] Nagoya Daini Hosp, Dept Pediat Nephrol, Japanese Red Cross, Aichi Med Ctr, Nagoya, Aichi, Japan

[8] Okinawa Prefectural Nanbu Med Ctr, Dept Pediat Nephrol, Childrens Med Ctr, Okinawa, Japan

[9] Jikei Univ, Dept Pediat, Sch Med, Tokyo, Japan

[10] Toho Univ, Dept Nephrol, Fac Med, Tokyo, Japan

[11] Aichi Childrens Hlth & Med Ctr, Dept Nephrol, Nagoya, Aichi, Japan

[12] Yokohama City Univ, Dept Pediat, Med Ctr, Yokohama, Kanagawa, Japan

[13] Kobe Univ, Dept Pediat, Grad Sch Med, Kobe, Hyogo, Japan

[14] Natl Ctr Child Hlth & Dev, Div Neonatol, Ctr Maternal Fetal Neonatal & Reprod Med, Tokyo, Japan

[15] Tokyo Metropolitan Childrens Med Ctr, Clin Res Support Ctr, Tokyo, Japan

[16] Teikyo Univ, Teikyo Acad Res Ctr, Tokyo, Japan

来源：

PEDIATRIC NEPHROLOGY | 2023年 / 38卷 / 04期

关键词：

Chronic kidney disease; Dialysis; Kidney transplantation; Children; Congenital anomalies of the kidney and urinary tract; Infants; GLOMERULAR-FILTRATION-RATE; JAPANESE CHILDREN; NATIONWIDE SURVEY; DISEASE; SURVIVAL; OUTCOMES;

D O I：

10.1007/s00467-022-05703-1

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Background Severe congenital anomalies of the kidney and urinary tract (CAKUT) progress to infantile kidney failure with replacement therapy (KFRT). Although prompt and precise prediction of kidney outcomes is important, early predictive factors for its progression remain incompletely defined. Methods This retrospective cohort study included patients with CAKUT treated at 12 centers between 2009 and 2020. Patients with a maximum serum creatinine level <= 1.0 mg/dL during the first 3 days, patients who died of respiratory failure during the neonatal period, patients who progressed to KFRT within the first 3 days, and patients lacking sufficient data were excluded. Results Of 2187 patients with CAKUT, 92 were finally analyzed. Twenty-five patients (27%) progressed to KFRT and 24 (26%) had stage 3-5 chronic kidney disease without replacement therapy during the median observation period of 52.0 (interquartile range, 22.0-87.8) months. Among these, 22 (24%) progressed to infantile KFRT. The kidney survival rate during the infantile period was significantly lower in patients with a maximum serum creatinine level during the first 3 days (Cr-day3-max) >= 2.5 mg/dL (21.8%) compared with those with a Cr-day3-max < 2.5 mg/dL (95.2%) (log-rank, P < 0.001). Multivariate analysis demonstrated Cr-day3-max (P < 0.001) and oligohydramnios (P = 0.025) were associated with higher risk of infantile KFRT. Eighty-two patients (89%) were alive at the last follow-up. Conclusions Neonatal kidney function, including Cr-day3-max, was associated with kidney outcomes in patients with severe CAKUT. Aggressive therapy for severe CAKUT may have good long-term life outcomes through infantile dialysis and kidney transplantation.

引用

页码：1057 / 1066

页数：10

共 21 条

[21] Clinical practice recommendations for the care of infants with stage 5 chronic kidney disease (CKD5)
Zurowska, Aleksandra M.
Fischbach, Michel
Watson, Alan R.
Edefonti, Alberto
Stefanidis, Constantinos J.
[J]. PEDIATRIC NEPHROLOGY, 2013, 28 (09) : 1739 - 1748

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