PLoS ONE (Jan 2019)

Development of a risk score for earlier diagnosis of chronic kidney disease in children.

  • Paulo Cesar Koch Nogueira,
  • Tulio Konstantyner,
  • Maria Fernanda Camargo de Carvalho,
  • Cristine Campos de Xavier Pinto,
  • Isabel de Pádua Paz,
  • Vera Maria Santoro Belangero,
  • Marcelo de Sousa Tavares,
  • Clotilde Druck Garcia,
  • Oreste Angelo Ferra Neto,
  • Káthia Liliane da Cunha Ribeiro Zuntini,
  • Marina da Rocha Lordelo,
  • Samira Shizuko Parreao Oi,
  • Renata Trindade Damasceno,
  • Ricardo Sesso

DOI
https://doi.org/10.1371/journal.pone.0215100
Journal volume & issue
Vol. 14, no. 4
p. e0215100

Abstract

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ObjectiveTo 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.Study designWe 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.ResultsIn 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).ConclusionsThe 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.