Children With Kidney Disease Have Greater Risk for Kidney Failure Later in Life

A new study notes that kidney disease in childhood is linked with an enhanced risk of end-stage renal disease (ESRD) in adulthood, irrespective of whether or not the kidney functions normally through adolescence.

The results, which were based on a population-based nationwide cohort study of 1,521,501 Israeli adolescents examined before compulsory military service in 1967 through 1997 suggests that structural abnormalities or kidney injury in children has eventual long term implications as reported in the New England Journal of Medicine (2018; 378:428-438) by investigators Ronit Calderon-Margalit, MD, MPH, of Hadassah-Hebrew University Braun School of Public Health, Hadassah Ein Kerem, Jerusalem, Israel, and colleagues.

The Israeli ESRD database was used to identify ESRD cases. And the follow-up, which was done for a period of 30 years in 2490 individuals, yielded a 5.93 incident rate per 100,000 person-years. There was a 4-fold increased risk of ESRD in people with a history of childhood kidney disease and the magnitude of this increase was similar across all types of kidney diseases. A childhood history of congenital anomalies of the pyelonephritis, kidney and urinary tract and glomerular disease were associated with a 4-fold, 5-fold, and 3.8-fold increased risk of ESRD, respectively.

Only conscripts who had no impaired renal function and no medical condition contributing to an increased risk of subsequent ESRD, such as hypertension and diabetes mellitus, at the time of conscription was included by the investigators for the primary analysis. The patients were aged 16-25 and had 17.7 to be their mean age at the initial medical assessment for conscription.

The authors concluded by stating that, “The current study suggests that mild kidney abnormalities or injury in childhood may confer a risk of ESRD in adulthood, even when there is no overt compromise of renal function in adolescence,” this result is consistent with the formulation that low nephron endowment or loss of nephrons can increase susceptibility to chronic diseases because of the hyper filtration of residual nephrons.”

In a supplementary editorial (pp. 470-471), Julie R. Ingelfinger, MD, Chief of the Division of Pediatric Nephrology at Massachusetts General Hospital in Boston, noted that; “results, just like the ones observed by Calderon-Margalit et al. suggest that there is a need to follow up people who has kidney disease in their childhood through out their life. We also have to get more effective predictors and techniques to intervene if we are to prevent ESRD in those who are susceptible.

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Ingelfinger JR. A disturbing legacy of childhood kidney disease. N Engl J Med. 2018; 378:470-471

Calderon-Margalit R, Golan E, Twig G, et al. History of childhood kidney disease and risk of adult end-stage renal disease. N Engl J Med. 2018; 378:428-438.