Common Clinical Markers Predict End-stage Renal Disease in Children with Obstructive Uropathy
Brian Becknell, MD, PhD Principal Investigator, Center for Clinical and Translational Research
Frequently measured clinical markers can predict end-stage renal disease in children with obstructive uropathy, a multicenter, collaborative study in Pediatric Nephrology shows.
Obstructive uropathy is a “blanket diagnosis,” explains Daryl McLeod, MD, a member of the Section of Urology at Nationwide Children’s. The term encompasses several complications that can occur during fetal development or after birth that impede urine flow and can ultimately injure the kidneys.
“A lot of damage has already occurred to the kidneys and urinary tract before we are able to intervene,” says Dr. McLeod. “We need a better way to identify which kids are going to have a worse course than others because up to 40 or 50% of these kids end up requiring dialysis or kidney transplant.”
“This study looks at a large prospective cohort of children with obstructive uropathy and identifies distinguishing features in their urine testing and serum chemistries that predict future need for renal replacement therapy,” says Brian Becknell, MD, PhD, a member of the Division of Nephrology and principal investigator in the Center for Clinical and Translational Research at Nationwide Children’s.
The researchers performed a retrospective review of data from the longitudinal dataset called CKiD, Chronic Kidney Disease in Children. After matching children who received renal replacement therapy with children who did not, the researchers found that all markers demonstrated some predictive value either at baseline, over time, or both.
The markers studied included: glomerular filtration rate, urine protein/Cr, urine microalbumin/Cr, serum hemoglobin, serum phosphate, serum albumin and serum CO2.
“This study had a lot of heterogeneity with regard to diagnosis,” says Dr. Becknell, who is also an assistant professor at The Ohio State University College of Medicine. “These kids might have had an obstruction, but we don’t know the level of that obstruction or the manner in which it was managed. That’s a really big deal. We need more uniform diagnostic groups of children to see how well these vital markers really perform. Then, we can ask how well they perform five, 10 or 15 years out; because in certain instances, children may require renal replacement therapy as adolescents instead of in the first several years of life.”
CITATION:
McLeod DJ, Ching CB, Sebastião YV, Greenberg JH, Furth SL, McHugh KM, Becknell B. Common Clinical Markers Predict End-Stage Renal Disease in Children with Obstructive Uropathy. Pediatric Nephrology. 2019 March; 34(3):443-448.
