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

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.

1. Staples A. O., Greenbaum L. A., Smith J. M., Gipson D. S., Filler G., Warady B. A. et al. Association between clinical risk factors and progression of chronic kidney disease in children. Clin J Am Soc Nephrol. 2010; 5: 2172–2179.

2. Kronenberg F. Emerging risk factors and markers of chronic kidney disease progression. Nat Rev Nephrol. 2009; 5: 677–689.

3. Warady B. A., Abraham A. G., Schwartz G. J., Wong C. S., Munoz A., Betoko А. et al. Predictors of rapid progression of glomerular and nonglomerular kidney disease in children and adolescents: The Chronic Kidney Disease in Children (CKiD) Cohort. Am J Kidney Dis. 2015. URL: http://www.ajkd.org/article/S0272-6386 (15)00090-6/abstract (дата обращения 03.06.2015).

4. Fathallah-Shaykh S. A., Flynn J. T., Pierce C. B., Abraham A. G., Blydt-Hansen T. D., Massengill S. F. et al. Progression of pediatric CKD of nonglomerular origin in the CKiD cohort. Clin J Am Soc Nephrol. 2015. URL: http://cjasn.asnjournals.org/content/early/2015/01/29/CJN.07480714.abstract (дата обращения 03.06.2015).

5. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation Classification Stratification. A. J. K. D. 2002; 39 (2 Suppl. 1): 1–266.

6. Schwartz G. J., Munoz A., Schneider M. F., Mak R. H., Kaskel F., Warady B. A., Furth S. L. et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009; 20: 629–637.

7. Пенкин В. Н., Ситникова В. П. Территориальные стандарты и показатели физического развития детей Воронежской области: Информационно-методическое пособие (справочник) для педиатров и врачей общей практики, интернов, клинических ординаторов. Воронеж. 2003. 47 с.

8. Национальные рекомендации по диагностике, лечению и профилактике артериальной гипертензии у детей и подростков (второй пересмотр). Кардиоваскулярная терапия и профилактика. 2009; 8 (4). Приложение 1: 253–288.

9. Bosch J. P., Saccaggi A., Lauer A. et al. Renal functional reserve in humans: Effect of protein intake on glomerular filtration rate. Am J Med. 1983; 75: 943–950.

10. Silva V. R. Soares C. B., Magalhaes J. O., Peixoto de Barcelos I., Cerqueira D. C., Simoes e Silva A. C., Oliveira E. A. Anthropometric and biochemical profile of children and adolescents with Chronic Kidney Disease in a Predialysis Pediatric Interdisciplinary Program. Scient World J. 2015. URL: http://dx.doi.org/10.1155/2015/810758 (дата обращения 01.04.2015)

11. ESPN/ERA-EDTA Registry. Paediatric Data 2010. [Электронный ресурс]. 2012. URL: http://www.espn-reg.org/files/ESPN%20ERAEDTA%20AR2010.pdf (дата обращения 03.06.2015).

12. U. S. Renal Data System, USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2013. URL: http://www.usrds.org/atlas.aspx (дата обращения 03.06.2015).

13. Настаушева Т. Л. Тубулоинтерстициальные поражения почек у детей с учетом факторов внешней среды. Автореф. дис. … докт. мед. наук: 14.00.09. Воронеж. 1997. 40 с.

14. Чичуга Е. М., Настаушева Т. Л., Жданова О. А., Звягина Т. Г., Стахурлова Л. И., Настаушева Н. С. Хроническая почечная недостаточность (хроническая болезнь почек 3–5 стадии) у детей Воронежского региона. Нефрология и диализ. 2014; 16: 2: 272–279.

15. Красных Л. В. Функциональное состояние единственной почки у детей. Автореф. дис. … канд. мед. наук: 14.00. Воронеж. 2008. 24 с.

16. Barai S., Gambhir S., Prasad N., Sharma R. K., Ora M. Functional renal reserve capacity in different stages of chronic kidney disease. Nephrology. 2010; 15 (3): 350–353.

17. Мстиславская С. А., Эмирова Х. М., Ольхова Е. Б. Оценка струк турно-функционального состояния единственной условно здоровой почки у детей. Педиатрия. 2012; 91 (6): 45–49.

18. Полещук Л. А. Состояние почечного кровотока у детей с поликистозной болезнью почек и наследственным нефритом. Автореф. дис. … канд. мед. наук: 14.00.09. Москва. 2007. 23 с.

19. Комарова О. В. Клинико-молекулярные основы прогрессирования хронической болезни почек у детей. Автореф. дис. … докт. мед. наук: 14.01.08. Москва. 2014. 47 с.

20. Strict Blood-Pressure Control and Progression of Renal Failure in Children. In: The ESCAPE Trial Group. N Engl J Med. 2009; 361: 1639–1650.

21. Flynn J. T., Mitsnefes M., Pierce C., Cole S. R., Parekh R. S., Furth S. L., Warady B. A. Blood pressure in children with chronic kidney disease: a report from the Chronic Kidney Disease in Children study. Hypertension. 2008; 52: 631–637.

22. Коровина Н. А., Захарова И. Н., Мумладзе Э. Б., Горяйнова А. Н. Инфекция мочевой системы у детей: современные подходы к диагностике и лечению. Русский медицинский журнал. 2007; 21: 1533–1542.

23. Игнатова М. С., Морозов С. Л., Крыганова Т. А., Шенцева Д. В., Назарова Н. Ф., Конькова Н. Е., Длин В. В. Современные представления о врожденных аномалиях органов мочевой системы (синдром CAKUT) у детей. Клиническая нефрология. 2013; 2: 58–64.

24. Renkema K. Y., Winyard P. J., Skovorodkin I. N., Levtchenko E. N., Hindryckx A., Jeanpierre C. et al. Novel perspectives for investigating congenital anomalies of the kidney and urinary tract (CAKUT). Nephrol Dial Transplant. 2011; 8 (12): 3843–3851.