Renal outcome in adults with renal insufficiency and irregular asymmetric kidneys.
BACKGROUND
The commonest cause of end-stage renal failure (ESRF) in children and young adults is congenital malformation of the kidney and urinary tract. In this retrospective review, we examine whether progression to ESRF can be predicted and whether treatment with angiotensin converting enzyme inhibitors (ACEI) can delay or prevent this.


METHODS
We reviewed 78 patients with asymmetric irregular kidneys as a consequence of either primary vesico-ureteric reflux or renal dysplasia (Group 1, n = 44), or abnormal bladder function (Group 2, n = 34). Patients (median age 24 years) had an estimated GFR (eGFR) < 60 ml/min/1.73 m2 with at least 5 years of follow up (median 143 months). 48 patients received ACEI. We explored potential prognostic factors that affect the time to ESRF using Cox-regression analyses.


RESULTS
At start, mean (SE) creatinine was 189 (8) mumol/l, mean eGFR 41 (1) ml/min 1.73 m2, mean proteinuria 144 (14) mg/mmol creatinine (1.7 g/24 hrs). Of 78 patients, 36 (46%) developed ESRF, but none of 19 with proteinuria less than 50 mg/mmol and only two of 18 patients with eGFR above 50 ml/min did so. Renal outcome between Groups 1 and 2 appeared similar with no evidence for a difference. A benefit in favour of treatment with ACEI was observed above an eGFR of 40 ml/min (p = 0.024).


CONCLUSIONS
The similar outcome of the two groups supports the nephrological nature of progressive renal failure in young men born with abnormal bladders. There is a watershed GFR of 40-50 ml/min at which ACEI treatment can be successful at improving renal outcome.
Institute of Urology and Nephrology, University College London, W1T 3AA, UK. g.neild@ucl.ac.uk
Guy H
GH
Neild
Gill
G
Thomson
Dorothea
D
Nitsch
Robin G
RG
Woolfson
John O
JO
Connolly
Christopher R J
CR
Woodhouse
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003404:Creatinine / Q000652:urine; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000652:urine
D000806:Angiotensin-Converting Enzyme Inhibitors; D003404:Creatinine