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Ultrasound-Based Renal Parenchymal Area and Kidney Function Decline in Infants With Congenital Anomalies of the Kidney and Urinary Tract

  • Bernarda Viteri
    Affiliations
    Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA

    Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA

    Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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  • Mohamed Elsingergy
    Affiliations
    Division of Body Imaging, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Jennifer Roem
    Affiliations
    Division of General Epidemiology and Methodology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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  • Derek Ng
    Affiliations
    Division of General Epidemiology and Methodology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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  • Bradley Warady
    Affiliations
    Department of Paediatrics, University of Missouri–Kansas City School of Medicine, Kansas City, MO
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  • Susan Furth
    Affiliations
    Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA

    Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

    Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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  • Gregory Tasian
    Correspondence
    Address reprint requests to Gregory Tasian, MD, Division of Pediatric Urology, Department of Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104.
    Affiliations
    Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

    Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA
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      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

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