Department of Pediatrics, Federal University of Sao Paulo, Sao Paulo, Brazil.
Hospital Samaritano de Sao Paulo, Sao Paulo, Brazil.
PLoS One. 2019 Apr 19;14(4):e0215100. doi: 10.1371/journal.pone.0215100. eCollection 2019.
To 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.
We 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.
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). 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).
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.
开发一种用于早期识别儿童和青少年慢性肾脏病（CKD）的临床评分。儿童期 CKD 的早期诊断可采取措施减缓疾病进展，从而降低发病率和死亡率。然而，由于诊断往往太晚，无法进行适当的患者管理。
我们对巴西多中心的 752 例儿科患者进行了病例对照研究；研究病例（n=376）为估算肾小球滤过率（eGFR）中位数为 37ml/min/1.73m2 的 CKD 患者（IQR=22-57）。对照组（n=376）为年龄、性别和中心匹配的因非肾脏疾病接受随访的儿童。通过包括症状、病史和临床检查的标准问卷调查潜在的危险因素。建立了两个多变量模型（A 和 B）来评估 CKD 诊断的预测因素。
在模型 A 中，9 个变量与 CKD 诊断相关：产前超声检查伴尿畸形、复发性尿路感染、多尿、尿液异常、夜尿、生长曲线平坦、高血压病史、泡沫尿和水肿（c 统计量=0.938）。模型 B 具有与模型 A 相同的变量，但增加了新生儿期住院史，且排除了产前超声变量（c 统计量=0.927）。
本评分可作为初级保健环境中专业人员诊断儿童 CKD 的预警信号，因为与 CKD 风险相关的症状可能被忽视。
