Quirino Isabel G, Dias Cristiane S, Vasconcelos Mariana A, Poggiali Isabel V, Gouvea Kerlane C, Pereira Alamanda K, Paulinelli Gabriela P, Moura Amanda R, Ferreira Raquel S, Colosimo Enrico A, Simões E Silva Ana Cristina, Oliveira Eduardo A
Pediatric Nephrology Unit, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, Faculty of Medicine, Federal University of Minas Gerais, Av Alfredo Balena, 190, Belo Horizonte, MG, 30130-100, Brazil.
Pediatr Nephrol. 2014 Dec;29(12):2357-64. doi: 10.1007/s00467-014-2870-z. Epub 2014 Jun 19.
The antenatal detection of congenital anomalies of the kidney and urinary tract (CAKUT) has permitted early management of these conditions. The aim of this study was to identify predictive factors associated with chronic kidney disease (CKD) in CAKUT. We also propose a risk score of CKD.
In this cohort study, 822 patients with prenatally detected CAKUT were followed up for a median time of 43 months. The primary outcome was CKD stage III or higher. A predictive model was developed using the Cox proportional hazards model and evaluated by using c statistics.
Chronic kidney disease occurred in 49 of the 822 (6 %) children with prenatally detected CAKUT. The most accurate model included bilateral hydronephrosis, oligohydramnios, estimated glomerular filtration rate and postnatal diagnosis. The accuracy of the score was 0.95 [95 % confidence interval (CI) 0.89-0.99] and 0.92 (95 % CI 0.86-0.95) after a follow-up of 2 and 10 years, respectively. Based on survival curves, we estimated that at 10 years of age, the probability of survival without CKD stage III was approximately 98 and 58 % for the patients assigned to the low-risk and high-risk groups, respectively (p < 0.001).
Our predictive model of CKD may contribute to an early identification of a subgroup of patients at high risk for renal impairment. It should be pointed out, however, that this model requires external validation in a different cohort.
产前检测先天性肾脏和尿路异常（CAKUT）有助于对这些疾病进行早期管理。本研究旨在确定与CAKUT患者慢性肾脏病（CKD）相关的预测因素。我们还提出了一个CKD风险评分。
在这项队列研究中，对822例产前检测出CAKUT的患者进行了中位时间为43个月的随访。主要结局为CKD III期或更高分期。使用Cox比例风险模型建立预测模型，并通过c统计量进行评估。
822例产前检测出CAKUT的儿童中有49例（6%）发生了慢性肾脏病。最准确的模型包括双侧肾积水、羊水过少、估计肾小球滤过率和产后诊断。随访2年和10年后，该评分的准确性分别为0.95[95%置信区间（CI）0.89 - 0.99]和0.92（95%CI 0.86 - 0.95）。根据生存曲线，我们估计在10岁时，低风险组和高风险组患者无CKD III期生存的概率分别约为98%和58%（p < 0.001）。
我们的CKD预测模型可能有助于早期识别有肾功能损害高风险的患者亚组。然而，应该指出的是，该模型需要在不同队列中进行外部验证。
