Yam Tseem Ceeb Rau Kev Loj Hlob Ntawm Kab Mob Raum Hniav: Kev Tshawb Fawb Hauv Cov Me Nyuam Prepubertal

Abstract

Aim: Cov kev tshawb fawb yav dhau los ntawm kev nce qib ntawmmob raum mob(CKD) in children have included older post-pubertal subjects. This study attempted to evaluate risk factors for the progression of CKD in pre-pubertal children. Methods: An observational study of children aged 2–10 years with an eGFR within the limits of >30i ib<75 mL/min/1.73 m2 was performed. Presenting clinical and biochemical risk factors, as well as diagnosis, were analyzed for their association with progression to kidney failure, time to kidney failure and for the rate of decline of kidney function. 

NYEM QHOV NO RAU CISTANCHE RAU QHOV 4 KIDNEY SAIB 

Cov txiaj ntsig: Ib puas thiab nees nkaum-tsib cov menyuam kawm tau kawm uas 42 (34%) tau nce mus rau CKD theem 5 thaum lub sijhawm nruab nrab ntawm kev soj ntsuam ntawm 3.1 (IQR=1.8–6) xyoo.Ntshav siab, anemia, thiab acidosis ntawm nkag tau cuam tshuam nrog kev loj hlob tab sis lawv tsis tau kwv yees txog qhov kawg. Tsuas yog kab mob glomerular, proteinuria, thiabtheem 4 kab mob raumtau ywj pheej kwv yees ntawm lub raum tsis ua haujlwm thiab lub sijhawm rau lub raum tsis ua haujlwm. Covtus nqi ntawm lub raum ua haujlwm poob qistau ntau dua hauv cov neeg mob glomerular dua li cov kab mob uas tsis yog glomerular.

Cov ntsiab lus: Cov kev pheej hmoo hloov pauv tau yooj yim, thaum tam sim no ntawm kev ntsuam xyuas thawj zaug, tsis yog tus kheej cuam tshuam nrog CKD kev loj hlob mus rau lub raum tsis ua haujlwm hauv cov menyuam yaus prepubertal. Tsuas yog tsis hloov pauv qhov kev pheej hmoo thiab cov proteinuria kwv yees qhov kawg ntawm 5 kab mob. Cov kev hloov pauv ntawm lub cev ntawm cov neeg laus tuaj yeem yog qhov ua rau lub raum tsis ua haujlwm thaum hluas.

KEYWORDSmob raum mob,raum, pediatric, puberty, txaus ntshai yam

Summary at a glance

Peb tau tshawb xyuas cov kev pheej hmoo ntawm kev nthuav qhia rau kev mob raum mob raum nyob rau hauv ib pawg ntawm cov me nyuam prepubertal. Feem ntau hloov kho qhov chaw kho mob ntshav siab, ntshav ntshav, thiab acidosis tsis taukwv yees lub raum tsis ua haujlwm. Proteinuria, theem 4 CKD, thiab kab mob glomerular tau cuam tshuam nrog kev loj hlob thiab lub sijhawm luv dua rau kev ua tsis tiav.

Taw qhia

Mob raum mob(CKD) yog qhov tsis tshua muaj tshwm sim tab sis tseem ceeb ua rau muaj mob hauv cov menyuam yaus. Kev xav thiab lub cev qhov tshwm sim yog lub nra hnyav rau cov neeg saib xyuas, thiab metabolic,mob plawv, thiablub cev los ntawmCKDraug kev puas tsuaj rau tus me nyuam.1 Lub koom haum yuav tsum kho cov me nyuam muaj zog thiab cov nqi siab. Hauv Tebchaws Meskas, qhov kev cia siab ntawm tus menyuam hnub nyoog qis dua 15 xyoos nrog CKD yog 30 xyoo.2 Muaj cov ntaub ntawv me me ntawm cov menyuam yaus CKD hauv tebchaws Africa uas qhov kev mob tshwm sim zoo li yuav tsis zoo vim kev kho tsis txaus thiab kev loj hlob sai dua. 4

Kev loj hlob tshwm sim feem ntau hauv CKD. Tus nqi ntawm lub raum poob qis yog qhov sib txawv thiab cuam tshuam los ntawm ob qho tib si hloov pauv thiab tsis hloov pauv yam tsis hloov.5 Pediatric nephrologists tsom mus rau retard qhov kev loj hlob no, txhawm rau ncua mus txog qhov tsis txaus ntawm kev ua haujlwm nephrons thiab qhov tshwm sim CKD theem 5. Nws yog ib qho tseem ceeb los txheeb xyuas qhov hloov pauv tau. uas ua rau muaj kev nce qib ntawm CKD.6–8 Hypertension9,10 thiab proteinuria11,12 tau pom tias yog cov kws tshaj lij ntawm kev nce qib ntawm CKD. Txawm li cas los xij, qee qhov kev tshawb fawb menyuam yaus tau suav nrog cov neeg laus, thiab hnub nyoog ntawm cov kev kawm suav nrog hauv kev tshawb fawb menyuam yaus sib txawv. Nephrologists lees paub tias kev puberty yog nrog los ntawm kev tsis zoo ntawm lub raum kev ua haujlwm thiab tuaj yeem ua rau lub raum hloov kho (KRT) hauv cov menyuam yaus uas muaj CKD.13,14 Qhov no yuav yog vim muaj kev ntxhov siab ntawm lub raum ua haujlwm los ntawm kev loj hlob spurt cuam tshuam nrog kev puberty. , thiab ua rau glomerular hypertension thiab hyperfiltration. Kev tshawb fawb txog kev loj hlob ntawm CKD hauv cov menyuam yaus yog li ntawd clouded los ntawm qhov kev tshwm sim loj ntawm lub cev. Qhov ua rau CKD hauv cov menyuam yaus feem ntau yog qhov txawv txav ntawm lub raum thiab cov zis (CAKUT), piv rau cov neeg laus, uas muaj ntshav qab zib thiab kub siab predominate.15 Yog li ntawd, cov kev pheej hmoo rau kev loj hlob ntawm CKD hauv cov menyuam yaus prepubertal, yuav muaj feem yuav. yuav txawv ntawm cov menyuam yaus thiab cov laus.

Muaj cov ntaub ntawv tsis txaus ntseeg txog qhov muaj feem cuam tshuam rau kev nce qib ntawm CKD hauv cov tebchaws tau nyiaj tsawg thiab nruab nrab (LMICs) 16 thiab tsis muaj dab tsi ntawm cov menyuam yaus prepubertal.

Qhov kev xav rau txoj kev tshawb fawb no yog tias cov kev pheej hmoo rau kev loj hlob ntawm CKD hauv cov menyuam yaus ua ntej yug menyuam yuav tsis zoo ib yam rau cov menyuam yaus thiab cov laus. Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim siab txog kev koom tes ntawm kev kho mob thiab biochemical tsis nyob rau ntawm qhov kev nthuav qhia ntawm cov me nyuam ua ntej pubertal nrog CKD, nrog rau kev loj hlob ntawm lub raum tsis ua hauj lwm mus rau CKD theem 5. Puberty nws tus kheej yog ib qho kev pheej hmoo, txoj kev tshawb no tsis tau hais txog qhov physiological teebmeem ntawm puberty rau kev loj hlob ntawm CKD, los yog tej yam muaj feem yuav tshwm sim tom qab puberty.

2|Txoj kev

A cohort study of patients attending the pediatric nephrology units at Steve Biko Academic Hospital and Morningside Children's Kidney Treatment Centre was undertaken. Both these clinics are affiliated to the University of Pretoria Medical School. Prepubertal children aged 2 to 10 years with CKD and an eGFR of >30 mas<75 mL/min/1.73 m2 were selected from the databases of the two clinics. Data of these patients was recorded retro- and prospectively. New patients meeting the GFR criteria were included as they presented, and their data was recorded prospectively. Patients were followed until they reached the endpoint of CKD stage 5 or the termination date of the study. Patients were excluded from analysis if they reached the age of 13 years or developed beyond Tanner stage 2, received a pre-emptive kidney transplant, or died before reaching the endpoint. While comprehensive data including sociodemographic factors were collected, variables for the assessment of the progression of kidney function decline were selected clinical and biochemical characteristics of the patients at the time they were included in the study and not at diagnosis of CKD. Serum albumin was excluded from all analyses because of its close inverse relationship, seen in these patients, with the urinary protein: creatinine ratio (UPCR). Categorical data that were recorded were age, sex, height-for-age Z score (stunted: below 10th percentile, severely stunted: below 5th percentile), CKD stage and etiology of CKD. The cut-off values chosen for variables are defined in the tables. Data of possible risk factor covariates of patients who had reached the eGFR endpoint by the termination of the study in March 2021 were analyzed. Estimated GFR was calculated using the modified bedside Schwartz formula, with a k-constant of 40 in all children.

Cov neeg mob tau nyob rau hauv kev saib xyuas thiab saib xyuas ntawm ob tug kws kho mob nephrologist. Lawv tau raug tswj xyuas raws li KDIGO cov txheej txheem kev kho mob thiab tau ua raws li 3-6 lub hlis ib zaug. Ntawm txhua qhov kev mus ntsib, kev tshuaj xyuas thiab tshuaj biochemical tau rov ua dua.

Anemia tau txhais tias yog hemoglobin ntawm<11 g/dL for children younger than 7 years of age and <11.5 g/dL for those older than 7 years. No blood transfusions were administered. Metabolic acidosis was defined as sHCO3 of less than 22 mmol/L. These children were treated with oral alkaline solutions.

Ntshav siab tau kuaj pom ntawm kev nthuav qhia rau tus kws kho mob nephrologist thiab suav nrog qee cov neeg mob uas twb tau txais kev kho mob ntshav siab. Qhov no tau hloov pauv raws li KDIGO cov lus qhia thaum tsim nyog. Cov ntsiab lus siv rau kev kho mob-naïve cov neeg mob yog systolic thiab / lossis diastolic ntshav siab Ntau dua lossis sib npaug li 95 feem pua ​​​​ntawm cov ntshav siab rau hnub nyoog, poj niam txiv neej, thiab qhov siab feem pua ​​​​raws li Daim Ntawv Qhia 4th ntawm National High Blood Pressure Education Program Working Group. on Cov Ntshav Siab Hauv Cov Me Nyuam thiab Cov Hluas.17 Cov ntshav siab tau ntsuas nrog lub tshuab oscillometric nrog tus menyuam nyob hauv qhov chaw zaum. Qhov nruab nrab ntawm peb qhov kev nyeem tau sau tseg thiab rov kuaj xyuas los ntawm nephrologist. Thaum angiotensin-hloov pauv enzyme inhibitors (ACEi) tuaj yeem ua haujlwm tsis zoo hauv kev kho mob ntshav siab hauv cov haiv neeg Africans, lawv tau raug sau tseg ua thawj kab kev kho mob ntshav siab thiab / lossis proteinuria hauv cov neeg mob glomerular. Calcium channel blockers (CCB) tau muab tshuaj rau cov menyuam yaus uas tsis yog-glomerular mob uas muaj ntshav siab tab sis tsis muaj, lossis tsis saib xyuas, proteinuria, lossis ACEi yog tias lawv muaj proteinuria. Kev kho ACEi raug txiav tawm yog tias tsim nyog los ntawm cov kev mob tshwm sim, lossis thaum txiav txim siab tsim nyog hauv tus neeg mob yog tias eGFR tsis kam<30 mL/min/1.73 m2 , such as if a child was likely to miss an appointment.

Cov neeg mob tau raug soj ntsuam rau peb qhov txiaj ntsig sib txawv: kev nce mus rau qhov kawg ntawm eGFR ntawm<15 mL/min/1.73 m2 , time to reach this endpoint and the rate of kidney function decline. The time-to-event analysis was calculated using the median time of survival of kidney function in years for 50% of patients for each risk factor. The rate of kidney function deterioration was categorized in decrements in GFR of <1, 1–3, 3–5 and >5 mL / min / 1.73 m2 / xyoo.

Sau ntawv tso cai rau kev koom nrog hauv txoj kev tshawb fawb tau txais los ntawm cov niam txiv lossis cov neeg saib xyuas ntawm txhua tus neeg mob. Cov txheej txheem kev tshawb fawb tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Ncaj Ncees ntawm Kws Qhia Kev Noj Qab Haus Huv ntawm University of Pretoria (Study 92/2013). Cov kws sau ntawv lees paub tias qhov kev tshawb fawb no tau ua raws li cov qauv kev coj ncaj ncees uas tau teev tseg los ntawm 1964 Tshaj Tawm ntawm Helsinki.

2.1|Kev txheeb cais

Qhov kawg ntawm qhov txiaj ntsig tau hloov pauv tau txhais tau tias yog qhov ua tiav ntawm eGFR ntawm<15 mL/min/1.73 m2 (CKD stage 5). Demographic and clinical characteristics were summarized for all patients by CKD diagnosis (glomerular and non-glomerular disorders) using mean and standard deviation (SD) for continuous variables, and percentages for categorical variables. Differences by diagnosis were tested using Wilcoxon rank sum tests for continuous variables and χ 2 tests for categorical variables. For each of the potential risk factors, univariate logistic regression was fitted, after which risk factors that were significant at the .15 level of significance were considered in a multivariable Cox regression analysis. Non-significant (p ≥ .05) risk factors were then manually removed one at a time, and when necessary re-inserted. After each removal/insertion, the Cox regression was fitted and assessed with a binary outcome for eGFR (>los yog<15 mL/min/1.73 m2 ). Kidney survival was defined, using the survivor function, as retention of function in 50% of patients. This is presented using the Kaplan–Meier method. Testing was done at the .05 level of significance.

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