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Pediatric Nephrology
Published in: Pediatric Nephrology 11/2015

01-11-2015 | Original Article

A predictive model of progressive chronic kidney disease in idiopathic nephrotic syndrome

Authors: Ana Carmen Quaresma Mendonça, Eduardo Araújo Oliveira, Brunna Pinto Fróes, Lauro Damasceno Carvalho Faria, Juliana Silva Pinto, Maira Melo Ibrahim Nogueira, Gabriella Oliveira Lima, Priscila Isa Resende, Natália Silva Assis, Ana Cristina Simões e Silva, Sérgio Veloso Brant Pinheiro

Published in: Pediatric Nephrology | Issue 11/2015

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Abstract

Background

There are limited data on the risk factors for chronic kidney disease (CKD) in children with idiopathic nephrotic syndrome (INS). This retrospective cohort study aimed to develop a predictive model for CKD progression in children with INS.

Methods

Between 1970 and 2012, a total of 294 patients with INS were followed up. The primary outcome was progression to CKD stage 3 or higher. A predictive model was developed using a Cox proportional hazards model. A score was calculated using b-coefficients and summing up points assigned to each significant variable. Prognostic score was grouped into categories: low risk, medium risk, and high risk.

Results

Median follow-up was 6.9 years. Median renal survival was 26.1 years and probability of CKD stage 3 or higher was 8 % in 10 years. Multivariate analysis showed that the most accurate model included initial age, hematuria, and steroid resistance. Accuracy was high with a c-statistic of 0.95 (95 % confidence interval [CI] 0.91–0.99), 0.92 (95 % CI 0.88–0.96), and 0.92 (95 % CI 0.87–0.97) at 2, 5, and 10 years of follow-up respectively. By survival analysis, 10-year renal survival was 100 % for the low-risk and 95 % for the medium-risk group, while 40 % of high-risk patients would exhibit CKD stage 3 or higher (P < 0.001).

Conclusions

Our predictive model of CKD may contribute to the early identification of a subgroup of INS patients at a high risk of renal dysfunction.
Literature
1.
Gipson DS, Massengill SF, Yao L, Nagaraj S, Smoyer WE, Mahan JD, Wigfall D, Miles P, Powell L, Lin JJ, Trachtman H, Greenbaum LA (2009) Management of childhood onset nephrotic syndrome. Pediatrics 124:747–757CrossRefPubMed
2.
Fakhouri F, Bocquet N, Taupin P, Presne C, Gagnadoux MF, Landais P, Lesavre P, Chauveau D, Knebelmann B, Broyer M, Grünfeld JP, Niaudet P (2003) Steroid-sensitive nephrotic syndrome: from childhood to adulthood. Am J Kidney Dis 41:550–557CrossRefPubMed
3.
Banazsak B, Banaszak P (2012) The increasing incidence of initial steroid resistance in childhood nephrotic syndrome. Pediatr Nephrol 27:927–932CrossRef
4.
Filler G, Young E, Geier P, Carpenter B, Drukker A, Feber J (2003) Is there really an increase in non-minimal change nephrotic syndrome in children? Am J Kidney Dis 42:1107–1113CrossRefPubMed
5.
Bibiloni Mdel M, Pons A, Tur JA (2013) Prevalence of overweight and obesity in adolescents: a systematic review. ISRN Obes 2013:392747PubMed
6.
Taal MW, Brenner BM (2006) Predicting initiation and progression of chronic kidney disease: developing renal risk scores. Kidney Int 70:1694–1705CrossRefPubMed
7.
8.
Staples AO, Greenbaum LA, Smith JM, Gipson DS, Filler G, Warady BA, Martz K, Wong CS (2010) Association between clinical risk factors and progression of chronic kidney disease in children. Clin J Am Soc Nephrol 5:2172–2179PubMedCentralCrossRefPubMed
9.
International Study of Kidney Disease in Children (1981) The primary nephrotic syndrome in children. Identification of patients with minimal change nephrotic syndrome from initial response to prednisone. A report of the International Study of Kidney Disease in Children. J Pediatr 98:561–564
10.
Tarshish P, Tobin JN, Bernstein J, Edelmann CM Jr (1997) Prognostic significance of the early course of minimal change nephrotic syndrome: report of the international study of kidney disease in children. J Am Soc Nephrol 8:769–776PubMed
11.
12.
Mendoza AS, Reznik M, Griswold WR, Krensky AM, Yorgin PD, Tune BM (1990) Treatment of steroid-resistant focal segmental glomerulosclerosis with pulse methylprednisolone and alkylating agents. Pediatr Nephrol 4:303–307CrossRefPubMed
13.
14.
National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) Fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576CrossRef
15.
16.
Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin N Am 34:571–590
17.
Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637PubMedCentralCrossRefPubMed
18.
Ravani P, Parfrey P, Gadag V, Malberti F, Barrett B (2007) Clinical research of kidney diseases III: principles of regression and modelling. Nephrol Dial Transplant 22:3422–3430CrossRefPubMed
19.
Cerqueira DC, Soares CM, Silva VR, Magalhães JO, Barcelos IP, Duarte MG, Pinheiro SV, Colosimo EA, Simões e Silva AC, Oliveira EA (2014) A predictive model of progression of CKD to ESRD in a predialysis pediatric interdisciplinary program. Clin J Am Soc Nephrol 9:728–735
20.
Sullivan LM, Massaro JM, D’Agostino RB Sr (2004) Presentation of multivariate data for clinical use: the Framingham study risk score functions. Stat Med 23:1631–1660CrossRefPubMed
21.
Moons KG, Kengne AP, Woodward M, Royston P, Vergouwe Y, Altman DG, Grobbee DE (2012) Risk prediction models. I. Development, internal validation, and assessing the incremental value of a new (bio)marker. Heart 98:683–690CrossRefPubMed
22.
Moons KG, Kengne AP, Grobbee DE, Royston P, Vergouwe Y, Altman DG, Woodward M (2012) Risk prediction models. II. External validation, model updating, and impact assessment. Heart 98:691–698CrossRefPubMed
23.
Harrell FE Jr, Lee KL, Mark DB (1996) Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 15:361–387CrossRefPubMed
24.
Cook NR, Buring JE, Ridker PM (2006) The effect of including C-reactive protein in cardiovascular risk prediction models for women. Ann Intern Med 145:21–29CrossRefPubMed
25.
Hosmer DW, Hosmer T, Le Cessie S, Lemeshow S (1997) A comparison of goodness-of-fit tests for the logistic regression model. Stat Med 16:965–980CrossRefPubMed
26.
Steyerberg EW, Vickers AJ, Cook NR, Gerds T, Gonen M, Obuchowski N, Pencina MJ, Kattan MW (2010) Assessing the performance of prediction models: a framework for traditional and novel measures. Epidemiology 21:128–138PubMedCentralCrossRefPubMed
27.
Steyerberg EW, Harrell FE Jr, Borsboom GJ, Eijkemans MJ, Vergouwe Y, Habbema JD (2001) Internal validation of predictive models: efficiency of some procedures for logistic regression analysis. J Clin Epidemiol 54:774–781CrossRefPubMed
28.
International Study of Kidney Disease in Children (1981) Primary nephrotic syndrome in children: clinical significance of histopathologic variants of minimal change and of diffuse mesangial hypercellularity. A report of the International Study of Kidney Disease in Children. Kidney Int 20:765–771
29.
McKinney PA, Feltbower RG, Brocklebank JT, Fitzpatrick MM (2001) Time trends and ethnic patterns of childhood nephrotic syndrome in Yorkshire, UK. Pediatr Nephrol 16:1040–1044CrossRefPubMed
30.
31.
32.
Mekahli D, Liutkus A, Ranchin B, Yu A, Bessenay L, Girardin E, Van Damme-Lombaerts R, Palcoux JB, Cachat F, Lavocat MP, Bourdat-Michel G, Nobili F, Cochat P (2009) Long-term outcome of idiopathic steroid-resistant nephrotic syndrome: a multicenter study. Pediatr Nephrol 24:1525–1532CrossRefPubMed
33.
Paik KH, Lee BH, Cho HY, Kang HG, Ha IS, Cheong HI, Jin DK, Moon KC, Choi Y (2007) Primary focal segmental glomerular sclerosis in children: clinical course and prognosis. Pediatr Nephrol 22:389–395CrossRefPubMed
34.
El-Refaey AM, Bakr A, Hammad A, Elmougy A, El-Houseeny F, Abdelrahman A, Sarhan A (2010) Primary focal segmental glomerulosclerosis in Egyptian children: a 10-year single centre experience. Pediatr Nephrol 25:1369–1373CrossRefPubMed
35.
Southwest Pediatric Nephrology Study Group (1985) Focal segmental glomerulosclerosis in children with idiopathic nephrotic syndrome. A report of the Southwest Pediatric Nephrology Study Group. Kidney Int 27:442–449CrossRef
36.
International Study of Kidney Disease in Children (1978) Nephrotic syndrome in children: prediction of histopathology from clinical and laboratory characteristics at time of diagnosis. A report of the International Study of Kidney Disease in Children. Kidney Int 13:159–165CrossRef
37.
Abrantes MM, Cardoso LSB, Lima EM, Silva JMP, Diniz JS, Bambirra EA, Oliveira EA (2006) Predictive factors of chronic kidney disease in primary focal segmental glomerulosclerosis. Pediatr Nephrol 21:1003–1012CrossRefPubMed
38.
Zagury A, Oliveira AL, Montalvão JAA, Novaes RHL, Moraes CAP, Tavares MS (2013) Síndrome Nefrótica córtico-resistente na criança: evolução e fatores de risco para doença renal crônica terminal. J Bras Nefrol 35:191–199CrossRefPubMed
39.
Wuhl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, Testa S, Jankauskiene A, Emre S, Caldas-Afonso A, Anarat A, Niaudet P, Mir S, Bakkaloglu A, Enke B, Montini G, Wingen AM, Sallay P, Jeck N, Berg U, Caliskan S, Wygoda S, Hohbach-Hohenfellner K, Dusek J, Urasinski T, Arbeiter K, Neuhaus T, Gellermann J, Drozdz D, Fischbach M, Moller K, Wigger M, Peruzzi L, Mehls O, Schaefer F (2009) ESCAPE Trial Group: strict blood pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650CrossRefPubMed
40.
Chang JW, Tsai HL, Yang LY, Chen TJ (2012) Epidemiology and predictors of end-stage renal disease in Taiwanese children with idiopathic nephrotic syndrome. J Epidemiol 22:517–522PubMedCentralCrossRefPubMed
41.
Szeto CC, Lai FM, Chow KM, Kwan BC, Kwong VW, Leung CB, Li PK (2014) Long-term outcome of biopsy-proven minimal change nephropathy in Chinese adults. Am J Kidney Dis 65:710–718CrossRefPubMed
42.
Ruth EM, Kemper MJ, Leumann EP, Laube GF, Neuhas TJ (2005) Children with steroid-sensitive nephrotic syndrome come of age: long-term outcome. J Pediatr 147:202–207CrossRefPubMed
43.
Chang JW, Tsai HL, Wang HH, Yang LY (2009) Clinicopathological features and prognosis of Chinese children with idiopathic nephrotic syndrome between different age groups. Eur J Pediatr 168:1189–1194CrossRefPubMed
44.
Cattran DC, Panduranga R (1998) Long-term outcome in children and adults with classic focal segmental glomerulosclerosis. Am J Kidney Dis 32:72–79
45.
Chun MJ, Korbet SM, Schwartz MM, Lewis EJ (2004) Focal segmental glomerulosclerosis in nephrotic adults: presentation, prognosis, and response to therapy of the histologic variants. J Am Soc Nephrol 15:2169–2177CrossRefPubMed
46.
Vivante A, Calderon-Margalit R, Skorecki K (2013) Hematuria and risk for end-stage kidney disease. Curr Opin Nephrol Hypertens 22:325–330CrossRefPubMed
47.
48.
Pereira WF, Brito-Melo GE, Guimarães FT, Carvalho TG, Mateo EC, Simões e Silva AC (2014) The role of the immune system in idiopathic nephrotic syndrome: a review of clinical and experimental studies. Inflamm Res 63:1–12
49.
Soares CM, Diniz JS, Lima EM, Silva JM, Oliveira GR, Canhestro MR, Colosimo EA, Simões e Silva AC, Oliveira EA (2008) Clinical outcome of children with chronic kidney disease in a pre-dialysis interdisciplinary program. Pediatr Nephrol 23:2039–2046
50.
Park M, Yoon E, Lim YH, Kim H, Choi J, Yoon HJ (2014) Renal hyperfiltration as a novel marker of all-cause mortality. J Am Soc Nephrol 26:1426–1433
Metadata
Title
A predictive model of progressive chronic kidney disease in idiopathic nephrotic syndrome
Authors
Ana Carmen Quaresma Mendonça
Eduardo Araújo Oliveira
Brunna Pinto Fróes
Lauro Damasceno Carvalho Faria
Juliana Silva Pinto
Maira Melo Ibrahim Nogueira
Gabriella Oliveira Lima
Priscila Isa Resende
Natália Silva Assis
Ana Cristina Simões e Silva
Sérgio Veloso Brant Pinheiro
Publication date
01-11-2015
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 11/2015
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-015-3136-0

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