Colceriu Marius-Cosmin, Aldea Paul Luchian, Bulată Bogdan, Delean Dan, Sevastre-Berghian Alexandra, Clichici Simona, Boț Răchişan Andreea-Liana, Mocan Teodora
Discipline of Physiology, Department of Functional Biosciences, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
Second Pediatric Discipline, Department of Mother and Child, "Iuliu Haţieganu" University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania.
Children (Basel). 2024 Jul 31;11(8):928. doi: 10.3390/children11080928.
BACKGROUND/OBJECTIVES: Congenital anomalies of the kidney and urinary tract (CAKUT) are the main cause of chronic kidney disease (CKD) requiring renal replacement therapy (RRT) in children, being the leading cause (50-70%) of end-stage renal disease (ESRD) in children and young adults. Our study aimed to assess the natural evolution of various antenatally diagnosed renal malformations and to identify potential prognostic factors to guide the therapeutic management of patients with CAKUT.
We conducted a retrospective study on 205 children with CAKUT. For each patient, analyzing their medical records, we established the nadir value of serum creatinine, defined as the lowest creatinine level during the first year of life. We assessed the value of nadir creatinine as a prognostic marker in patients with CAKUT, and using an ROC curve, we also determined a threshold value of nadir creatinine that predicted progression to ESRD.
The male-to-female ratio was 2.8 to 1. The mean gestational age at detection was 29.85 weeks (±6.71). A total of 36 patients (17.6%) had impaired renal function, of which 8 (3.9% of the total) progressed to ESRD. The mean nadir creatinine in patients with ESRD was 1.39 mg/dL. A nadir creatinine cut-off of 0.98 mg/dL had high sensitivity and specificity in identifying patients with progression to ESRD, with an AUC of 0.95 and a 95% confidence interval between 0.86 and 1.05 mg/dL.
Our results support the value of nadir creatinine in predicting progression to ESRD, consistent with previously published data.
背景/目的：先天性肾脏和尿路畸形（CAKUT）是儿童慢性肾脏病（CKD）需要肾脏替代治疗（RRT）的主要原因，是儿童和青年终末期肾病（ESRD）的主要病因（50 - 70%）。我们的研究旨在评估各种产前诊断的肾脏畸形的自然病程，并确定潜在的预后因素，以指导CAKUT患者的治疗管理。
我们对205例CAKUT患儿进行了一项回顾性研究。对于每例患者，通过分析其病历，我们确定了血清肌酐的最低点值，定义为生命第一年期间的最低肌酐水平。我们评估了最低点肌酐值作为CAKUT患者预后标志物的价值，并使用ROC曲线确定了预测进展为ESRD的最低点肌酐阈值。
男女比例为2.8比1。检测时的平均胎龄为29.85周（±6.71）。共有36例患者（17.6%）肾功能受损，其中8例（占总数的3.9%）进展为ESRD。ESRD患者的平均最低点肌酐为1.39 mg/dL。最低点肌酐临界值为0.98 mg/dL在识别进展为ESRD的患者方面具有高敏感性和特异性，AUC为0.95，95%置信区间在0.86至1.05 mg/dL之间。
我们的结果支持最低点肌酐在预测进展为ESRD方面的价值，与先前发表的数据一致。
