Asia Pacific Journal of Pediatric and Child Health

Abstract Ref Number = APCP99

Invited Speakers

Epidemiology of CKD in children and evaluation of kidney function

Kenji Ishikura Division of Nephrology and Rheumatology, National Center for Child Health and Development

Chronic kidney disease (CKD) in children is a progressive and intractable condition that may severely impair the child’s growth, development, and quality of life. Management during pre-dialysis phase is critical since permanent disabilities can be modified or even prevented in this phase. However, epidemiological information on these children, particularly in Asians, has been scant. To address this problem of limited information in Asian children, the Committee of Measures for Pediatric CKD of the Japanese Society for Pediatric Nephrology has conducted several studies to determine reference levels of serum creatinine (SCr), cystatin C, and β2-microgloburin in Japanese children. Furthermore, the equations for estimating glomerular filtration rates based on these biomarkers have been also established. In 2010, we conducted a nation-wide survey of Japanese children aged 3 months to 15 years with pre-dialysis CKD to examine the prevalence and basic characteristics of these children (P-CKD Study). CKD was diagnosed and classified according to newly established criteria derived from reference serum creatinine levels in Japanese children. Since then, using this cohort, a prospective cohort study has been conducted to date. Information on 447 children was collected; 70.5% of children had stage 3 CKD, 23.9% stage 4, and 5.6% stage 5. The estimated prevalence of Japanese children with stage 3-5 CKD was 29.8 cases/1,000,000 children. Of 407 CKD cases with non-glomerular disease, of these 278 (68.3%) had congenital anomalies of the kidney and urinary tract (CAKUT). Follow-up study showed that renal survival rates at 1 year were 98.3, 80.0 and 40.9%, for stages 3, 4 and 5 CKD, respectively. Higher CKD stage, age (< 2 years and after starting puberty), and heavy proteinuria were significantly associated with disease progression. Marked growth impairment in these children including those with stage 3 CKD and its progression with advance in CKD stage were also shown. In addition, effect of VUR on progression to ESKD in these children was examined, but VUR was not associated with disease progression in CKD children with CAKUT. We have also shown that both birth weight and gestational age are strongly associated with childhood-onset CKD. Our results showed that CKD in children, mainly consists of CAKUT, is rarer than in adults, but is progressive and has complications peculiar to children. We believe that our study has contributed to explore relevant epidemiological information in Asian children. Improved management of CAKUT in children with CKD, including renoprotective treatment and urological interventions, is required.

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