Clinical analysis of 108 cases with chronic kidney disease at stage 2 to 5 in children

Abstract

Objective To analyze the pathogenesis, initially diagnosed symptoms and clinical manifestations of children with chronic kidney disease(CKD) at stage 2 to 5. Methods The data of 108 children who were hospitalized in Children′s Hospital Affiliated to Capital Institute of Pediatrics from September 2007 to April 2016 with CKD stage 2 to 5 were retrospectively analyzed.The etiologies, clinical manifestations and examinations were summarized, and the clinical manifestations were compared between the congenital hereditary urinary diseases group and the acquired urinary diseases group. Results (1) In the 108 cases collected, 66 cases were male, 42 cases were female, aged from 3 months to 15 years and 1 month old.Twenty-four cases were diagnosed at stage 2, 26 cases at stage 3, 35 cases at stage 4, and 23 cases at stage 5.(2)Twenty-eight kinds of illness were involved in the cause of CKD.Among them, 57 cases(52.8%) had congenital anomalies of the kidney and urinary tract, 5 cases(4.6%) had hereditary kidney diseases, 41 cases(38.0%) had other primary or secondary kidney diseases, and in 5 cases(4.6%) the causes of disease were unknown.(3) For the initially diagnosed symptoms, 29 cases(26.9%) were due to complaints associated with kidney disease, 36 cases(33.3%) were of other outside kidney symptoms, and 43 cases(39.8%) were of negative symptoms.The results of urinary ultrasound were abnormal in 79 cases(73.1%) and 87 cases(80.6%) showed abnormality in urinary analysis.There were 105 cases (97.2%) with abnormal manifestations either in urinary tract ultrasound or in urinary analysis.(4)The ages on diagnosis as CKD in children with congenital hereditary urinary diseases(5.89 years old) were younger than that of children with acquired urinary diseases(9.20 years old), and the difference was significant(Z=-3.434, P=0.001). The frequency of cases with short stature or lower-weight in group of congenital hereditary urinary diseases[66.1%(41/62 cases), 64.5%(40/62 cases)] were significantly higher than those of the acquired urinary diseases group[43.9%(18/41cases), 43.9%(18/41 cases)], and the differences were statistically significant(χ2=4.983, 4.263, P=0.026, 0.039). Conclusions The causes of CKD are complicated, and the congenital anomalies of kidney and urinary tract are the major causes of CKD at stage 2 to 5 in the cases.The initially diagnosed symptoms of CKD are insidious and atypical.The children with congenital hereditary urinary diseases tend to have more serious growth retardation.Urinary analysis and ultrasound may have an important significance for early diagnosis of CKD in children. Key words: Chronic kidney disease; Child; Etiology; Clinical manifestation