Markers of Chronic Kidney Disease in Children with Obstructive Uropathy or Vesicoureteral Reflux

Abstract

Background. Identification of markers of chronic kidney disease and its progression in the early stages of the disease is important, however, the most of research concerns late (3–5) stages of the disease. Objective . Identification of the markers of chronic kidney disease (CKD) and its progression in the early stages of the disease in children with obstructive uropathy and vesicoureteral reflux. Methods. Prospective follow-up (for 5 years) of 92 children with obstructive and reflux uropathies (1st to 4th stages of CKD). All patients had episodes of urinary tract infections, mostly pyelonephritis, minimum once a year. Results . High prevalence of proteinuria (60.9%), reduced renal functional reserve (88.7%) and disorders of cortical renal blood flow (by Doppler Color Flow Imaging) (69.6%) were found in children with 1st stage of CKD. Groups of children with proteinuria and a reduced renal functional reserve had a higher level of systolic and diastolic blood pressure in comparison with the patients without proteinuria and the reduced renal functional reserve (p < 0.05). In patients with 2–4 stages of CKD the glomerular filtration rate (GFR) correlated with atypical flora in the etiology of urinary tract infections (rpb = 0.66; n = 23; p = 0.0006), sex (boys had lower levels of GFR, rpb = 0.61; n = 23; p = 0.001), bilateral renal abnormalities (rpb = -0.53; n = 23; p = 0.009) the level of hemoglobin (r = 0.45; n = 23; p = 0.02). Conclusion . Markers of CKD of children with obstructive and reflux uropathies are: proteinuria, arterial hypertension, reduction of renal functional reserve and the impaired cortical renal blood flow (by Doppler Color Flow Imaging). The importance of arterial hypertension and proteinuria as markers of the progression of CKD of children with urinary tract obstruction and vesicoureteral reflux was confirmed. Additional markers for the progression of CKD in children with obstructive and reflux uropaties might be: male sex, bilateral renal abnormalities, anemia and atypical bacteriuria during relapses of urinary tract infections.