Early predictive factors for progression to kidney failure in infants with severe congenital anomalies of the kidney and urinary tract
verfasst von:
Kentaro Nishi, Osamu Uemura, Ryoko Harada, Masaki Yamamoto, Yusuke Okuda, Kenichiro Miura, Yoshimitsu Gotoh, Tomoo Kise, Daishi Hirano, Yuko Hamasaki, Naoya Fujita, Toru Uchimura, Takeshi Ninchoji, Tetsuya Isayama, Riku Hamada, Koichi Kamei, Tetsuji Kaneko, Kenji Ishikura, on behalf of the Pediatric CKD Study Group in Japan in conjunction with the Committee of Measures for Pediatric CKD of the Japanese Society of Pediatric Nephrology
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.
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Early predictive factors for progression to kidney failure in infants with severe congenital anomalies of the kidney and urinary tract
verfasst von
Kentaro Nishi Osamu Uemura Ryoko Harada Masaki Yamamoto Yusuke Okuda Kenichiro Miura Yoshimitsu Gotoh Tomoo Kise Daishi Hirano Yuko Hamasaki Naoya Fujita Toru Uchimura Takeshi Ninchoji Tetsuya Isayama Riku Hamada Koichi Kamei Tetsuji Kaneko Kenji Ishikura on behalf of the Pediatric CKD Study Group in Japan in conjunction with the Committee of Measures for Pediatric CKD of the Japanese Society of Pediatric Nephrology
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