Development of a risk score for earlier diagnosis of chronic kidney disease in children.

Autor: Nogueira PCK; Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil., Konstantyner T; Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil., Carvalho MFC; Hospital Samaritano de Sao Paulo, Sao Paulo, Brazil., Pinto CCX; Escola de Economia de Sao Paulo, Fundação Getúlio Vargas, Sao Paulo, Brazil., Paz IP; Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil., Belangero VMS; Department of Pediatrics, State University of Campinas, Campinas, Brazil., Tavares MS; Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil., Garcia CD; Department of Pediatrics, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil., Neto OAF; Hospital Universitário Maria Aparecida Pedrossian, Campo Grande, Brazil., Zuntini KLDCR; Hospital Infantil Albert Sabin de Fortaleza, Fortaleza, Brazil., Lordelo MDR; Hospital Martagão Gesteira, Salvador, Brazil., Oi SSP; Federal University of Maranhao, Sao Luis, Brazil., Damasceno RT; Santa Casa do Pará, Belém, Brazil., Sesso R; Nephrology Division, Federal University of Sao Paulo, Sao Paulo, Brazil.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2019 Apr 19; Vol. 14 (4), pp. e0215100. Date of Electronic Publication: 2019 Apr 19 (Print Publication: 2019).
DOI: 10.1371/journal.pone.0215100
Abstrakt: Objective: To develop a clinical score for the early identification of chronic kidney disease (CKD) in children and adolescents. The early diagnosis of CKD in childhood allows the adoption of measures to slow the progression of the disease, thereby reducing morbidity and mortality. Nevertheless, the diagnosis is often made too late for proper patient management.
Study Design: We preformed a case-control study of a multicenter Brazilian sample of 752 pediatric patients; the study cases (n = 376) were CKD patients with a median estimated GFR of 37 (IQR = 22 to 57) ml/min/1.73 m2. The control group (n = 376) comprised age-, gender- and center-matched children who were followed for nonrenal diseases. Potential risk factors were investigated through a standard questionnaire that included symptoms, medical history, and a clinical examination. Two multivariable models (A and B) were fitted to assess predictors of the diagnosis of CKD.
Results: In model A, 9 variables were associated with CKD diagnosis: antenatal ultrasound with urinary malformation, recurrent urinary tract infection, polyuria, abnormal urine stream, nocturia, growth curve flattening, history of hypertension, foamy urine and edema (c-statistic = 0.938). Model B had the same variables as model A, except for the addition of the history of admission during the neonatal period and the exclusion of antenatal ultrasound variables (c-statistic = 0.927).
Conclusions: The present scores may serve as a warning sign for CKD diagnosis in children among professionals working in the primary care setting where the symptoms associated with a risk of CKD may be overlooked.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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