(Reuters Health) – Children who recover from kidney disease face a four-fold increased risk of end-stage renal disease (ESRD) in adulthood, according to researchers who retrospectively studied 1.5 million residents of Israel examined for compulsory military service.
The increased risk was seen among adults who had normal kidney function and blood pressure at the time of military conscription and regardless of the type of childhood kidney problems. The reason is unclear.
“Our results suggest that clinicians should be aware of the residual risk for chronic kidney disease among adults with a history of kidney disease in childhood. This applies especially to young adults,” Dr. Ronit Calderon-Margalit of the Hadassah-Hebrew University Braun School of Public Health, in Jerusalem, told Reuters Health by email.
“We have reasonable parameters for kidney function, but relatively poor indicators for kidney reserve,” Dr. Calderon-Margalit said. “We hypothesized that even mild childhood kidney disease that has seemingly resolved may cause subclinical kidney damage.”
The study was published online January 31 in The New England Journal of Medicine.
The childhood problems the team studied included congenital anomalies of the kidney and urinary tract that didn’t affect renal function in adolescence, along with short-term pyelonephritis and glomerular disease.
After three decades of follow-up, the research team identified 18,592 people with a history of childhood kidney disease. ESRD eventually occurred in 140, making it 4.19 times more common in people with childhood renal problems.
People with no history of childhood kidney disease had an ESRD incidence of 1 in 19,417 per year. With any type of childhood kidney disease it was 1 in 4,255.
Risks calculated by the type of childhood disease compared to those with no childhood kidney disease were:
– 5.19 times higher for people with a history of congenital anomalies of the kidney and urinary tract after adjustment for age, place of birth, body-mass index and other factors.
– 8.14 times higher among people in that group who had received surgery and attained normal renal function.
– 4.03 times higher following pyelonephritis in childhood.
– 3.85 times higher following cases of childhood glomerular disease.
Military conscriptees with any evidence of impaired renal function, diabetes, hypertension, cancer, lupus, vasculitis or any rheumatic disease were excluded from the analysis.
“We were not surprised by the direction of the associations that we have found,” said Dr. Calderon-Margalit. “However, we were quite surprised to see that these associations applied to all childhood disease categories. Furthermore, we were surprised that these associations remained strong even in later birth cohorts.”
“The interpretation of our findings should take into account that ESRD is estimated to represent only 0.1% to 2.0% of all patients with chronic kidney disease, which includes earlier stages before ESRD,” the researcher said. “The finding of a possible risk of ESRD associated with childhood kidney diseases implies that there is an even greater, albeit unmeasured, risk of the considerably more prevalent antecedent stages of chronic kidney disease.”
SOURCE: http://bit.ly/2DFJKNl
N Engl J Med 2018.
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