title: Proteinuria as a predictor of disease progression in children with hypodysplastic nephropathy. Data from the Ital Kid Project.
abstract: Little is known about the role of proteinuria in the progression of childhood renal diseases. We analyzed the decline in creatinine clearance ( C(Cr)) and kidney survival in 225 children (185 males) with chronic renal failure (CRF) due to isolated hypodysplasia or hypodysplasia associated with urological abnormalities. The data were based on the information available in the Italian Pediatric Registry of CRF (ItalKid Project), which includes patients from all of Italy aged <20 years with C(Cr )levels of <75 ml/min per 1.73 m(2). Patients aged <2 years and those with C(Cr )levels of <20 ml/min per 1.73 m(2) or a follow-up of <1 year were excluded from the analysis, as were those receiving angiotensin-converting enzyme inhibitors. At baseline, the patients had a mean age of 7.8+/-4.2 years, a mean C(Cr )of 50+/-16.3 ml/min per 1.73 m(2), a median urinary protein/urinary creatinine (uPr/uCr) ratio of 0.38 (range 0.02-7.21), and a mean duration of follow-up of 3.5+/-1.1 years. The patients were divided into three groups on the basis of their baseline proteinuria levels: group A normal (uPr/uCr <0.2) n=83; group B low (uPr/uCr 0.2-0.9) n=71; and group C mild (uPr/uCr >0.9) n=71. Patients in groups A and B showed a significantly slower decline in C(Cr )than those in group C (slope +0.16+/-3.64 and -0.54+/-3.67 vs. -3.61+/-5.47, P<0.0001) and a higher rate of kidney survival after 5 years (96.7% and 94.1% vs. 44.9%, P<0.01). By multivariate analysis, the baseline uPr/uCr ratio ( P<0.01) and age ( P<0.0001) correlated with a faster decline in C(Cr )irrespective of baseline C(Cr). There was no correlation with mean arterial blood pressure. We conclude that proteinuria is an independent predictor of progression to end-stage renal failure also in children whose renal impairment is due to congenital hypodysplasia.
authors.affiliation: Department of Pediatrics, Clinica Pediatrica De Marchi, Via Commenda 9, 20122, Milan, Italy. italkid@italkid.org
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ardissino
authors.forename: Sara
authors.initials: S
authors.lastname: Testa
authors.forename: Valeria
authors.initials: V
authors.lastname: Daccò
authors.forename: Sara
authors.initials: S
authors.lastname: Viganò
authors.forename: Emanuela
authors.initials: E
authors.lastname: Taioli
authors.forename: Aldo
authors.initials: A
authors.lastname: Claris-Appiani
authors.forename: Mirella
authors.initials: M
authors.lastname: Procaccio
authors.forename: Luigi
authors.initials: L
authors.lastname: Avolio
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciofani
authors.forename: Luca
authors.initials: L
authors.lastname: Dello Strologo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini
mesh_terms: D002648:Child; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D018450:Disease Progression; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000503:physiopathology*; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011507:Proteinuria / Q000209:etiology* / Q000652:urine; D016019:Survival Analysis
chemical_list: D003404:Creatinine