Summary
Congenital anomalies of the kidney and urinary tract are the leading cause of chronic
kidney disease in children. Noninvasive imaging biomarkers that predict chronic kidney
disease progression in early infancy are needed. We performed a pilot study nested
in the prospective Chronic Kidney Disease in Children cohort study to determine the
association between renal parenchymal area (RPA) on first post-natal renal ultrasound
and change in estimated glomerular filtration rate (eGFR) in children with congenital
anomalies of the kidney and urinary tract. Among 14 participants, 78.6% were males,
the median age at the time of the ultrasound was 3.4 months (interquartile range,
1.3-7.9 mo), and the median total RPA z-score at baseline was -1.01 (interquartile
range, -2.39 to 0.52). After a median follow-up period of 7.4 years (interquartile
range, 6.8-8.2 y), the eGFR decreased from a median of 49.4 mL/min per 1.73 m2 at baseline to 29.4 mL/min per 1.73 m2, an annual eGFR percentage decrease of -4.68%. Lower RPA z-scores were correlated
weakly with a higher annual decrease in eGFR (Spearman correlation, 0.35; 95% confidence
interval, -0.25 to 0.76). This pilot study shows the feasibility of obtaining RPA
from a routine ultrasound and suggests that a lower baseline RPA may be associated
with a greater decrease in eGFR over time. Further studies with larger patient cohorts
are needed to confirm this association.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Seminars in NephrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Epidemiology of chronic kidney disease in children.Pediatr Nephrol. 2012; 27: 363-373
- Chronic kidney disease in the neonate: etiologies, management, and outcomes.Semin Fetal Neonatal Med. 2017; 22: 98-103
- [Etiological analysis of 264 cases with chronic kidney disease stage 2 to 5 in children].Zhonghua Er Ke Za Zhi. 2015; 53: 665-669
- Congenital anomalies of the kidney and the urinary tract (CAKUT).Fetal Pediatr Pathol. 2014; 33: 293-320
- Novel insights into the pathogenesis of monogenic congenital anomalies of the kidney and urinary tract.J Am Soc Nephrol. 2018; 29: 36-50
- Clinical implications of the solitary functioning kidney.Clin J Am Soc Nephrol. 2014; 9: 978-986
- The clinical importance of nephron mass.J Am Soc Nephrol. 2010; 21: 898-910
- Novel biomarkers in the diagnosis of chronic kidney disease and the prediction of its outcome.Int J Mol Sci. 2017; 18: 1702
- Chronic kidney disease in children.Clin Kidney J. 2016; 9: 583-591
- Remnant nephron physiology and the progression of chronic kidney disease.Pediatr Nephrol. 2014; 29: 193-202
- Renal parenchymal area and risk of ESRD in boys with posterior urethral valves.Clin J Am Soc Nephrol. 2014; 9: 499-505
- Prevalence and predictors of renal functional abnormalities of high grade vesicoureteral reflux.J Urol. 2013; 190: 1490-1494
- Quantitative ultrasound renal parenchymal area correlates with renal volume and identifies reflux nephropathy.J Urol. 2009; 182: 1683-1687
- Sonographic renal parenchymal measurements for the evaluation and management of ureteropelvic junction obstruction in children.Front Pediatr. 2016; 4: 42
A Muñoz, S Furth, D Warady. Chronic kidney disease in children prospective cohort study. [cited 2021 April 30]. Available from: https://clinicaltrials.gov/ct2/show/NCT00327860.
- Design and methods of the Chronic Kidney Disease in Children (CKiD) prospective cohort study.Clin J Am Soc Nephrol. 2006; 1: 1006-1015
- NIH image to ImageJ: 25 years of image analysis.Nat Methods. 2012; 9: 671-675
- Renal parenchymal area growth curves for children 0 to 10 months old.J Urol. 2016; 195: 1203-1208
- Smoothing reference centile curves: the LMS method and penalized likelihood.Stat Med. 1992; 11: 1305-1319
- Relationships of measured iohexol GFR and estimated GFR with CKD-related biomarkers in children and adolescents.Am J Kidney Dis. 2017; 70: 397-405
- Clinical practice guideline for screening and management of high blood pressure in children and adolescents.Pediatrics. 2017; 140e20171904
- Stature in children with chronic kidney disease: analysis of NAPRTCS database.Pediatr Nephrol. 2006; 21: 793-799
- Etiology and treatment of growth retardation in children with chronic kidney disease and end-stage renal disease: a historical perspective.Pediatr Nephrol. 2010; 25: 725-732
- Short stature in advanced pediatric CKD is associated with faster time to reduced kidney function after transplant.Pediatr Nephrol. 2019; 34: 897-905
- The impact of short stature on health-related quality of life in children with chronic kidney disease.J Pediatr. 2013; 163 (736-41.e1)
- Reference values for serum creatinine in children younger than 1 year of age.Pediatr Nephrol. 2010; 25: 2107-2113
- Neonatal kidney size and function in preterm infants: what is a true estimate of glomerular filtration rate?.J Pediatr. 2014; 164 (1026-31.e2)
- Correction to: neonatal hypertension: cases, causes, and clinical approach.Pediatr Nephrol. 2019; 34: 1637
Wang H, Pulido JE, Song Y, et al. Segmentation of renal parenchymal area from ultrasound images using level set evolution. In: 2014 36th Annual International Conference of the IEEE Engineering in Medicine and Biology Society; 2014 Aug 26-30, EMBC 2014; Chicago, IL. p. 4703-6.
- The horse-racing effect.Lancet. 1981; 2: 467-468
- When is baseline adjustment useful in analyses of change? An example with education and cognitive change.Am J Epidemiol. 2005; 162: 267-278
- Clinical significance of contrast-enhanced ultrasound in chronic kidney disease: a pilot study.J Ultrasound. 2019; 22: 453-460
- Usefulness of contrast-enhanced ultrasound in the evaluation of chronic kidney disease.Curr Med Imaging. 2021;17:1003-9;
- Image texture features predict renal function decline in patients with autosomal dominant polycystic kidney disease.Kidney Int. 2017; 92: 1206-1216
- Multi-instance deep learning of ultrasound imaging data for pattern classification of congenital abnormalities of the kidney and urinary tract in children.Urology. 2020; 142: 183-189
Article info
Footnotes
Financial support: Research reported in this publication was funded by The Children's Hospital of Philadelphia Pediatric Center of Excellence in Nephrology and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number P50DK114786. Research also was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under training award number T32 DK007006. The Chronic Kidney Disease in Children study is supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, with additional funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Heart, Lung, and Blood Institute (U01 DK066143, U01 DK066174, U24 DK082194, and U24 DK066116). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of interest statement: none.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
