Portal de Periódicos da CAPES

LONG-TERM OUTCOME OF VESICOURETERAL REFLUX ASSOCIATED CHRONIC RENAL FAILURE IN CHILDREN. DATA FROM THE ITALKID PROJECT

2004; Lippincott Williams & Wilkins; Volume: 172; Issue: 1 Linguagem: Inglês

10.1097/01.ju.0000129067.30725.16

1527-3792

Gianluigi Ardissino, Luigi Avolio, Valeria Daccò, Sara Testa, Giuseppina Marra, Sarà Vigano, Silvana Loi, Paolo Caione, Roberto De Castro, Salvatore De Pascale, Efisia Marras, Giovanna Riccipetitoni, G Selvaggio, Paola Pedotti, Aldo Claris-Appiani, Antonio Ciofani, Luca Dello Strologo, Giuliana Lama, Giovanni Montini,

Metabolism and Genetic Disorders

No AccessJournal of UrologyPediatric Urology1 Jul 2004LONG-TERM OUTCOME OF VESICOURETERAL REFLUX ASSOCIATED CHRONIC RENAL FAILURE IN CHILDREN. DATA FROM THE ITALKID PROJECT GIANLUIGI ARDISSINO, LUIGI AVOLIO, VALERIA DACCO, SARA TESTA, GIUSEPPINA MARRA, SARA VIGANÒ, SILVANA LOI, PAOLO CAIONE, ROBERTO DE CASTRO, SALVATORE DE PASCALE, EFISIA MARRAS, GIOVANNA RICCIPETITONI, GIORGIO SELVAGGIO, PAOLA PEDOTTI, ALDO CLARIS-APPIANI, ANTONIO CIOFANI, LUCA DELLO STROLOGO, GIULIANA LAMA, GIOVANNI MONTINI, and ENRICO VERRINA ON BEHALF OF THE ITALKID PROJECT GIANLUIGI ARDISSINOGIANLUIGI ARDISSINO More articles by this author , LUIGI AVOLIOLUIGI AVOLIO More articles by this author , VALERIA DACCOVALERIA DACCO More articles by this author , SARA TESTASARA TESTA More articles by this author , GIUSEPPINA MARRAGIUSEPPINA MARRA More articles by this author , SARA VIGANÒSARA VIGANÒ More articles by this author , SILVANA LOISILVANA LOI More articles by this author , PAOLO CAIONEPAOLO CAIONE More articles by this author , ROBERTO DE CASTROROBERTO DE CASTRO More articles by this author , SALVATORE DE PASCALESALVATORE DE PASCALE More articles by this author , EFISIA MARRASEFISIA MARRAS More articles by this author , GIOVANNA RICCIPETITONIGIOVANNA RICCIPETITONI More articles by this author , GIORGIO SELVAGGIOGIORGIO SELVAGGIO More articles by this author , PAOLA PEDOTTIPAOLA PEDOTTI More articles by this author , ALDO CLARIS-APPIANIALDO CLARIS-APPIANI More articles by this author , ANTONIO CIOFANIANTONIO CIOFANI More articles by this author , LUCA DELLO STROLOGOLUCA DELLO STROLOGO More articles by this author , GIULIANA LAMAGIULIANA LAMA More articles by this author , GIOVANNI MONTINIGIOVANNI MONTINI More articles by this author , and ENRICO VERRINA ON BEHALF OF THE ITALKID PROJECT More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000129067.30725.16AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The nephropathy associated with vesicoureteral reflux (VUR) is one of the leading causes of chronic renal failure (CRF) in children. We describe the clinical course of the disease based on information available in the ItalKid Project database, and analyze the predictive value of baseline renal function, age at VUR diagnosis and urinary protein excretion in relation to the risk of progressive renal failure. Materials and Methods: As of December 31, 2001 the registry included a total of 343 patients (261 males) with a diagnosis of primary VUR, which was the leading single cause of CRF, accounting for 25.4% of all patients with CRF. Results: The estimated risk of end stage renal disease (ESRD) by age 20 years was 56%. The patients with a creatinine clearance (Ccr) of less than 40 ml per minute at baseline had an estimated 4-fold greater risk of ESRD developing in comparison with those whose Ccr was 40 to 75 ml per minute. No significant difference in probability of disease progression to ESRD was found between subjects diagnosed with VUR at age 6 months or less and those diagnosed later (older than 6 months). Furthermore, children with normal urinary protein excretion (a urinary protein [uPr]/urinary creatinine [uCr] ratio of less than 0.2 in 36 patients) and low grade proteinuria (uPr/uCr 0.2 to 0.8 in 34 patients) at baseline showed a significantly slower decrease in mean Ccr than those with moderate proteinuria (uPr/uCr greater than 0.8 in 34 patients). Hypertension and/or antihypertensive treatment (including antiprogressive drugs) were reported in 29.1% of patients. Conclusions: The results of the present study define the long-term risk of ESRD in a large population of children with CRF and VUR, and provide some critical information for identifying the prognosis. References 1 : Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics2003; 111: e382. Google Scholar 2 : Chronic renal failure in children: an epidemiological survey in Lorraine (France) 1975–1990. Pediatr Nephrol1994; 8: 472. Google Scholar 3 : Medical versus surgical treatment of primary vesicoureteral reflux: a prospective international reflux study in children. J Urol1981; 125: 277. Google Scholar 4 Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five years’ observation. Birmingham Reflux Study Group. Br Med J1987; 295: 237. Google Scholar 5 : Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial. Lancet2001; 357: 1329. Google Scholar 6 : Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy?. Pediatrics2000; 105: 1236. Google Scholar 7 : A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics1976; 58: 259. Google Scholar 8 Report of the Second Task Force on Blood Pressure Control in Children—1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics1987; 79: 1. Google Scholar 9 : Factors affecting chronic renal failure progression: results from a multicentre trial. The Northern Italian Cooperative Study Group. Miner Electrolyte Metab1992; 18: 295. Google Scholar 10 : Abnormal permeability to proteins and glomerular lesions: a meta-analysis of experimental and human studies. Am J Kidney Dis1996; 27: 34. Google Scholar 11 : Impact of arterial blood pressure and albuminuria on the progression of diabetic nephropathy in IDDM patients. Diabetes1993; 42: 715. Google Scholar 12 : Predictors of the progression of renal insufficiency in patients with insulin-dependent diabetes and overt diabetic nephropathy. The Collaborative Study Group. Kidney Int1996; 50: 1651. Google Scholar 13 : Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med1995; 123: 754. Google Scholar 14 : Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Lancet1997; 349: 1117. Google Scholar 15 : Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med1983; 309: 1543. Google Scholar 16 : Cross-sectional longitudinal study of spot morning urine protein: creatinine ratio, 24-hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes. BMJ1998; 316: 504. Google Scholar 17 : Is glomerulosclerosis a consequence of altered glomerular permeability to macromolecules?. Kidney Int1990; 38: 384. Google Scholar 18 : Interstitial nephritis induced by protein-overload proteinuria. Am J Pathol1989; 135: 719. Google Scholar 19 : Long-term prognosis of chronic idiopathic membranous glomerulonephritis. An analysis of 334 cases with particular regard to tubulo-interstitial changes. Clin Nephrol1989; 31: 67. Google Scholar 20 : Vesicoureteral reflux diagnosed in adulthood. Incidence of urinary tract infections, hypertension, proteinuria, back pain and renal calculi. Nephrol Dial Transplant1997; 12: 2580. Google Scholar From the Unit of Pediatric Nephrology, Dialysis and Transplantation (GA, GM, SV, SL), Department of Pediatrics (VD, ST, AC-A), DeMarchiu, Division of Pediatric Surgery, Ospedale “F Buzzi” (GS), Epidemiology Unit, IRCCS Ospedale Maggiore (PP), Milan, Division of Pediatric Surgery, IRCCS Policlinico S. Matteo, Pavia (LA), Divisions of Pediatric Urology (PC) and Pediatric Nephrology (LDS), IRCCS Ospedale Pediatrico “Bambino Gesù,” Rome, Division of Pediatric Surgery, Ospedale Maggiore, Bologna (RDC), Division of Pediatric Surgery, Ospedali Riuniti, Bergamo (SDP), Division of Pediatric Urology, OIRM, Turin (EM), Division of Pediatric Surgery, Azienda Ospedaliera, Cosenza (GR), Division of Nephrology, Ospedale Civile “S. Spirito,” Pescara (AC), Department of Pediatrics, II Università di Napoli, Naples (GL), Unit of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, Padua (GM), Division of Pediatric Nephrology, Ospedale Pediatrico “Giannina Gaslini,” Genoa (EV), Italy© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byKang M, Lee J, Im Y, Choi H and Park K (2015) Predictive Factors of Chronic Kidney Disease in Patients with Vesicoureteral Reflux Treated Surgically and Followed after PubertyJournal of Urology, VOL. 195, NO. 4 Part 1, (1100-1106), Online publication date: 1-Apr-2016.Skoog S and Steinhardt G (2018) Prophylaxis Versus No Prophylaxis for RefluxJournal of Urology, VOL. 187, NO. 4, (1161-1163), Online publication date: 1-Apr-2012.Dodson J, Jerry-Fluker J, Ng D, Moxey-Mims M, Schwartz G, Dharnidharka V, Warady B and Furth S (2018) Urological Disorders in Chronic Kidney Disease in Children Cohort: Clinical Characteristics and Estimation of Glomerular Filtration RateJournal of Urology, VOL. 186, NO. 4, (1460-1466), Online publication date: 1-Oct-2011.Podestá M, Castera R and Chappero L (2018) Renal Parenchyma Abnormalities in Infants With Dilating Vesicoureteral Reflux: Relation to Reflux Severity and Pressure at OnsetJournal of Urology, VOL. 183, NO. 6, (2367-2372), Online publication date: 1-Jun-2010.Novak T, Mathews R, Martz K and Neu A (2009) Progression of Chronic Kidney Disease in Children With Vesicoureteral Reflux: The North American Pediatric Renal Trials Collaborative Studies DatabaseJournal of Urology, VOL. 182, NO. 4S, (1678-1682), Online publication date: 1-Oct-2009.Dodson J, Cohn S, Cox C, Hmiel P, Wood E, Mattoo T, Warady B and Furth S (2009) Urinary Incontinence in the CKiD Cohort and Health Related Quality of LifeJournal of Urology, VOL. 182, NO. 4S, (2007-2014), Online publication date: 1-Oct-2009. Volume 172Issue 1July 2004Page: 305-310 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordsvesicoureteral refluxkidney failure, chronictreatment outcomeMetricsAuthor Information GIANLUIGI ARDISSINO More articles by this author LUIGI AVOLIO More articles by this author VALERIA DACCO More articles by this author SARA TESTA More articles by this author GIUSEPPINA MARRA More articles by this author SARA VIGANÒ More articles by this author SILVANA LOI More articles by this author PAOLO CAIONE More articles by this author ROBERTO DE CASTRO More articles by this author SALVATORE DE PASCALE More articles by this author EFISIA MARRAS More articles by this author GIOVANNA RICCIPETITONI More articles by this author GIORGIO SELVAGGIO More articles by this author PAOLA PEDOTTI More articles by this author ALDO CLARIS-APPIANI More articles by this author ANTONIO CIOFANI More articles by this author LUCA DELLO STROLOGO More articles by this author GIULIANA LAMA More articles by this author GIOVANNI MONTINI More articles by this author ENRICO VERRINA ON BEHALF OF THE ITALKID PROJECT More articles by this author Expand All Advertisement PDF downloadLoading ...