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

Paulo Cesar Koch Nogueira,Marcelo De Sousa Tavares,Clotilde Druck Garcia,Vera Maria Santoro Belangero,Maria Fernanda Camargo De Carvalho,Oreste Angelo Ferra Neto,Isabel De Pádua Paz,Samira Shizuko Parreao Oi,Cristine Campos De Xavier Pinto,Marina Da Rocha Lordelo,Renata Trindade Damasceno,Tulio Konstantyner,Káthia Liliane Da Cunha Ribeiro Zuntini,Ricardo Sesso,Giuseppe Remuzzi

doi:10.1371/journal.pone.0215100

Abstract

ObjectiveTo 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 designWe 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.ResultsIn 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).ConclusionsThe 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.

Highlights

Chronic kidney disease (CKD) in children is a major disorder that leads to health system overload and represents a challenge, mainly in developing countries [1,2,3]
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)
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

Summary

Introduction

Chronic kidney disease (CKD) in children is a major disorder that leads to health system overload and represents a challenge, mainly in developing countries [1,2,3]. This disease usually progresses to the loss of kidney functions, leading to the need for renal replacement therapy (RRT), which has a huge impact on patients’ health conditions and family dynamics [4,5]. Late diagnosis of CKD entails three potential consequences to patients: many of them might die from preventable complications of CKD without having had a definitive diagnosis; many of them did not underwent measures in the early stages of the disease to reduce the rate of CKD progression; and many of them did not have adequate preparation time and organization of the families for RRT initiation, as well as for the health facilities, which can lead to higher morbidity and mortality [7,12,13]

Methods

Results

Conclusion