TY - JOUR
T1 - Renal outcome in patients with congenital anomalies of the kidney and urinary tract
AU - Sanna-Cherchi, Simone
AU - Ravani, Pietro
AU - Corbani, Valentina
AU - Parodi, Stefano
AU - Haupt, Riccardo
AU - Piaggio, Giorgio
AU - Innocenti, Maria L Degli
AU - Somenzi, Danio
AU - Trivelli, Antonella
AU - Caridi, Gianluca
AU - Izzi, Claudia
AU - Scolari, Francesco
AU - Mattioli, Girolamo
AU - Allegri, Landino
AU - Ghiggeri, Gian Marco
PY - 2009/9
Y1 - 2009/9
N2 - Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) are a major cause of morbidity in children. We measured the risk of progression to end-stage renal disease in 312 patients with CAKUT preselected for the presence of anomalies in kidney number or size. A model of dialysis-free survival from birth was established as a function of the renal CAKUT categories of solitary kidney; unilateral and bilateral hypodysplasia; renal hypodysplasia associated with posterior urethral valves; and multicystic and horseshoe kidney. Cox regression analysis took into account the concomitant presence of vesicoureteral reflux, year of diagnosis, and time-varying values of serum creatinine, proteinuria, and hypertension. By 30 years of age, 58 patients had started dialysis, giving a yearly incidence of 0.023 over a combined 2474 patient risk years. The risk for dialysis was significantly higher for patients with a solitary kidney or with renal hypodysplasia associated with posterior urethral valves (hazard ratios of 2.43 and 5.1, respectively) compared to patients with unilateral or bilateral renal hypodysplasia, or multicystic or horseshoe kidney, and was independent of other prognostic factors. Our study shows that sub-clinical defects of the solitary kidney may be responsible for a poorer prognosis compared to more benign forms of CAKUT. Prospective studies are needed to validate these results.
AB - Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) are a major cause of morbidity in children. We measured the risk of progression to end-stage renal disease in 312 patients with CAKUT preselected for the presence of anomalies in kidney number or size. A model of dialysis-free survival from birth was established as a function of the renal CAKUT categories of solitary kidney; unilateral and bilateral hypodysplasia; renal hypodysplasia associated with posterior urethral valves; and multicystic and horseshoe kidney. Cox regression analysis took into account the concomitant presence of vesicoureteral reflux, year of diagnosis, and time-varying values of serum creatinine, proteinuria, and hypertension. By 30 years of age, 58 patients had started dialysis, giving a yearly incidence of 0.023 over a combined 2474 patient risk years. The risk for dialysis was significantly higher for patients with a solitary kidney or with renal hypodysplasia associated with posterior urethral valves (hazard ratios of 2.43 and 5.1, respectively) compared to patients with unilateral or bilateral renal hypodysplasia, or multicystic or horseshoe kidney, and was independent of other prognostic factors. Our study shows that sub-clinical defects of the solitary kidney may be responsible for a poorer prognosis compared to more benign forms of CAKUT. Prospective studies are needed to validate these results.
KW - CAKUT
KW - End-stage renal disease
KW - Pediatric renal disease
KW - Survival analysis
KW - Vesicoureteral reflux
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U2 - 10.1038/ki.2009.220
DO - 10.1038/ki.2009.220
M3 - Article
C2 - 19536081
AN - SCOPUS:68949211778
VL - 76
SP - 528
EP - 533
JO - Kidney International
JF - Kidney International
SN - 0085-2538
IS - 5
ER -