Histologic characterization and risk factors for persistent albuminuria in adolescents in a region of highly prevalent end-stage renal failure of unknown origin

Autor: Dulce M Macias Diaz, Myriam del Carmen Corrales Aguirre, Ana Lilian Reza Escalera, Maria Teresa Tiscareño Gutiérrez, Itzel Ovalle Robles, Mariana Jocelyn Macías Guzmán, Andrea L García Díaz, Mauricio C Gutiérrez Peña, Andrea Natalia Alvarado-Nájera, Israel González Domínguez, Juan Carlos Villavicencio-Bautista, Angela Azucena Herrera Rodríguez, Ricardo Marín-García, Francisco Javier Avelar González, Alfredo Chew Wong, Elba Galván Guerra, Rodolfo Delgadillo Castañeda, Carlos Alberto Prado Aguilar, Leslie P Zúñiga-Macías, José Manuel Arreola Guerra
Rok vydání: 2022
Předmět:
Zdroj: Clinical Kidney Journal. 15:1300-1311
ISSN: 2048-8513
2048-8505
DOI: 10.1093/ckj/sfac018
Popis: Background End-stage renal failure of unknown origin (ESRD-UO) is a public health problem in Mexico and many regions of the world. The prevalence of ESRD-UO in Aguascalientes, Mexico, is one of the highest worldwide, particularly in adults between 20 and 40 years of age. Our aim was to screen adolescents for chronic kidney disease (CKD) to identify risk factors and histologically characterize adolescents with persistent albuminuria. Methods This was a cross-sectional, observational and comparative study of adolescents in whom serum creatinine and the albumin:creatinine ratio (ACR) were determined when screening for CKD. A clinical evaluation and risk factor survey were conducted. Patients with an abnormal ACR (≥30 mg/g) or a low glomerular filtration rate (GFR) (≤75 mL/min/1.73 m2) were re-evaluated and a renal ultrasound (US) was obtained. A kidney biopsy was performed in patients with persistent albuminuria. Results A total of 513 students were included; 19 had persistent albuminuria and 494 were controls. The prevalence of persistent albuminuria was 3.7% [95% confidence interval (CI) 2.1–5.3]. Only one patient had a decreased GFR. None of the patients with persistent albuminuria had anatomical abnormalities of the urinary tract by renal US. Patients with persistent albuminuria had a decreased total renal volume compared with the control group (150 versus 195 mL/m2; P Conclusions The prevalence of persistent albuminuria in adolescents in Aguascalientes is high and histologic compromise is characterized by podocyte injury in the absence of fibrosis. The renal volume of persistent albuminuria patients was decreased, suggesting oligonephronia. Exposure to environmental toxins such as pesticides, even prenatally, may be responsible for this pathological entity. Screening programs in adolescents by determining ACR are necessary in this setting.
Databáze: OpenAIRE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje