Proteinuria as a predictor of disease progression in children with hypodysplastic nephropathy

Ardissino, Gianluigi
Testa, Sara
Daccò, Valeria
Viganò, Sara
Taioli, Emanuela
Claris-Appiani, Aldo
Procaccio, Mirella
Avolio, Luigi
Ciofani, Antonio
Strologo, Luca Dello
Montini, Giovanni

¹Unit of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, Clinica Pediatrica De Marchi, Via Commenda 9, 20122 Milan, Italy
²Department of Pediatrics, Clinica Pediatrica De Marchi, Milan, Italy
³Epidemiology Unit, IRCCS Ospedale Maggiore, Milan, Italy
⁴Division of Pediatric Surgery, IRCCS Policlinico S. Matteo, Pavia, Italy
⁵Division of Nephrology, Ospedale Civile “S. Spirito”, Pescara, Italy
⁶Division of Pediatric Nephrology, Ospedale Pediatrico “Bambino Gesù”, Rome, Italy
⁷Unit of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, Ospedale Civile, Padua, Italy

Received: 12 August 2002/Accepted: 24 June 2003/Published online: 13 December 2003

This paper was written on behalf of all the members of the ItalKid Project whose contribution has been essential. Members of the ItalKid Project:

G. Aceto (Bari), G. Airoldi (Borgomanero), G. Amici (Ancona), A. Ammenti (Parma), B. Andretta (Padova), G. Ardissino (Milano), F. Ardito (Bologna), B. Assael (Verona), L. Avolio (Pavia), S. Bassi (Montichiari), F. Battaglino (Vicenza), R. Bellantuono (Bari), A. Bettinelli (Merate), C. Bigi (Lecco), S. Binda (Varese), C. Bini (Como), D. Bissi (Gallarate), R. Boero (Torino), R. Bonaudo (Torino), A. Bordugo (Pordenone), M. Borzani (Milano), M. Bosio (Milano), A. Bottelli (Varese), G. Bovio (Pavia), A. Bracone (Bra), G. Capasso (Napoli), M. Capizzi (Milano), D. Caringella (Bari), I. Carnera (Siracusa), M.R. Caruso (Bergamo), D. Cattarelli (Brescia), V. Cecchetti (Milano), M. Cecconi (Ancona), V. Cecinati (Bari), A. Ciofani (Pescara), A. Claris-Appiani (Milano), R. Coppo (Torino), F. Corona (Milano), A. Corsini (Bentivoglio), R. Costanzo (Ragusa), P. Cussino (Savigliano), M. D'Agostino (Bergamo), V. Daccò (Milano), G. Daidone (Siracusa), R. Dall'Amico (Thiene), L. Dardanelli (Cuneo), R. De Castro (Bologna), V. De Cristofaro (Sondrio), M. De Gennaro (Roma), S. De Pascale (Bergamo), N. De Santo (Napoli), D. Delfino (R. Calabria), C.A. Dell'Agnola (Milano), L. Dello Strologo (Roma), L. Dertenois (Genova), A. Dessanti (Sassari), A. Di Benedetto (Catania), A. Di Leone (Cosenza), F. Di Lorenzo (Bologna), P. Di Turi (Bologna), A. Edefonti (Milano), W. Erckert (Silandro), A. Fabris (Verona), V. Fanos (Verona), C. Fede (Messina), A. Fella (Napoli), R. Ferraro (Scorrano), M.T. Ferrazzano (Anzio), R. Ferré (Breno), A. Ferretti (Napoli), B. Fogazzi (Brescia), P. Formentin (Cittadella), C. Fortini (Ferrara), E. Fossali (Milano), G. Fossati Bellani (Milano), M. Gaido (Torino), R. Galato (Milano), G. Gargano (Modena), V. Georgacopulo (Ferrara), L. Ghio (Milano), R. Giachino (Ivrea), M. Giani (Milano), S. Gianni (Siracusa), B. Gianoglio (Torino), M. Girodano (Bari), V. Goj (Milano), F. Grancini (Milano), G. Grott (Chieri), S. Guez (Milano), R. Gusmano (Genova), A. Iovino (Napoli), C. Isimbaldi (Lecco), A. La Manna (Napoli), G. Lama (Napoli), R. Landoni (Cinisello B.), S. Li Volti (Catania), A. Liardo (Caltagirone), V. Lotti (Cesena), R. Lubrano (Roma), I. Luongo (Napoli), E. Mancini (Bologna), N. Manganaro (Messina), M. Marangella (Torino), C. Marchesoni (Trento), K. Marenzi (Segrate), S. Maringhini (Palermo), G. Marra (Milano), E. Marras (Torino), V. Mei (Bologna), F. Menni (Milano), N. Miglietti (Brescia), R. Mignani (Rimini), P. Minelli (Bologna), R. Moioli (Milano), P. Molinari (Bologna), G. Montini (Padova), M. Montis (Cagliari), G. Mosiello (Roma), L. Murer (Padova), G. Nebbia (Milano), M. Neunhauserer (Brunico), P. Nitsch (Parma), M. Noto (Palermo), C. Oppezzo (Milano), F. Paolillo (Lodi), T. Papalia (Cosenza), R. Parini (Milano), L. Parola (Magenta), F. Passione (Foggia), L. Pavanello (CastelfrancoV.), C. Pecoraro (Napoli), M. Pedron (Bolzano), I. Pela (Firenze), A. Pellegatta (Busto Arsizio), P. Pelliccia (Chieti), M. Pennesi (Trieste), C. Pennetta (Manduria), R. Penza (Bari), L. Peratoner (Pordenone), F. Perfumo (Genova), G. Perino (Torino), C. Pesce (Vicenza), L. Pisanello (Padova), M. Pitter (Mirano), L. Pontesilli (Roma), M. Porcellini (Torino), A. Pota (Napoli), R. Prandini (Bologna), F. Puteo (Bari), I. Ratsch (Ancona), E. Ravaioli (Rimini), G. Remuzzi (Bergamo), G. Riccipetitoni (Cosenza), G. Ripanti (Pesaro), G. Rizzoni (Roma), N. Roberto (Milano), A. Rosini (Ancona), M. Rossi Doria (Bologna), S. Rota (Bergamo), M. Ruzza (Milano), D. Scorrano (Belluno), A. Selicorni (Milano), G. Selvaggio (Milano), F. Sereni (Milano), O. Sernia (Savigliano), C. Setzu (Cagliari), C. Sforzini (Milano), L. Stallone (S. Giovanni Rotondo), M. Tagliaferri (Treviglio), L. Tampieri (Lugo), A. Testagrossa (Messina), A. Turrisi (Trapani), G. Vallini (Cinisello Balsamo), E. Verrina (Genova), S. Viola (Pavia), G. Visconti (Palermo), A. Voghenzi (Ferrara), G. Zacchello (Padova)

Pediatric Nephrology 19(2):p 172-177, February 2004. | DOI: 10.1007/s00467-003-1268-0

Abstract

Little is known about the role of proteinuria in the progression of childhood renal diseases. We analyzed the decline in creatinine clearance (C_Cr) and kidney survival in 225 children (185 males) with chronic renal failure (CRF) due to isolated hypodysplasia or hypodysplasia associated with urological abnormalities. The data were based on the information available in the Italian Pediatric Registry of CRF (ItalKid Project), which includes patients from all of Italy aged <20 years with C_Cr levels of <75 ml/min per 1.73 m². Patients aged <2 years and those with C_Cr levels of <20 ml/min per 1.73 m² or a follow-up of <1 year were excluded from the analysis, as were those receiving angiotensin-converting enzyme inhibitors. At baseline, the patients had a mean age of 7.8±4.2 years, a mean C_Cr of 50±16.3 ml/min per 1.73 m², a median urinary protein/urinary creatinine (uPr/uCr) ratio of 0.38 (range 0.02-7.21), and a mean duration of follow-up of 3.5±1.1 years. The patients were divided into three groups on the basis of their baseline proteinuria levels: group A normal (uPr/uCr <0.2) n=83; group B low (uPr/uCr 0.2-0.9) n=71; and group C mild (uPr/uCr >0.9) n=71. Patients in groups A and B showed a significantly slower decline in C_Cr than those in group C (slope +0.16±3.64 and -0.54±3.67 vs. -3.61±5.47, P<0.0001) and a higher rate of kidney survival after 5 years (96.7% and 94.1% vs. 44.9%, P<0.01). By multivariate analysis, the baseline uPr/uCr ratio (P<0.01) and age (P<0.0001) correlated with a faster decline in C_Cr irrespective of baseline C_Cr. There was no correlation with mean arterial blood pressure. We conclude that proteinuria is an independent predictor of progression to end-stage renal failure also in children whose renal impairment is due to congenital hypodysplasia.