Kidney Disease in Childhood Increases Adult ESRD Risk

Any history of childhood kidney disease is associated with a substantially increased risk of end stage renal disease (ESRD) in adulthood, reports a study from Israel in The New England Journal of Medicine.

The historical cohort study included more than 1.5 million Israeli adolescents undergoing medical assessment before military conscription between 1967 and 1997. History of childhood kidney disease was assessed, including congenital anomalies of the kidney and urinary tract, pyelonephritis, and glomerular disease. When evaluated at a mean age of 17.7 years, all individuals had normal kidney function and blood pressure.

Risk of ESRD in adulthood was assessed by linkage to the national ESRD registry. During a mean follow-up of 30 years, 2490 individuals developed ESRD.

Any type of childhood kidney disease was associated with a fourfold increase in the risk of ESRD during adulthood: hazard ratio (HR) 4.19. Adjusted HRs were 5.19 for congenital anomalies, 4.03 for pyelonephritis, and 3.85 for glomerulonephritis.

Childhood kidney disease was also associated with younger age at ESRD onset, with an HR of 10.40 for risk of ESRD among adults younger than 40. The excess risk decreased with longer follow-up, but remained significant up to 40 years’ follow-up.

Although most childhood kidney disease has a favorable prognosis, the impact on lifelong risk of chronic kidney disease has been unclear. This nationwide study shows an increased risk of ESRD among those with any history of childhood kidney disease, despite apparently normal kidney function in adolescence.

This risk may stem from hyperfiltration of remaining nephrons in patients with early kidney disease. The researchers conclude that their findings may imply “an even greater, albeit unmeasured, risk of the considerably more prevalent antecedent stages of chronic kidney disease” [Calderon-Margalit R, et al. History of childhood kidney disease and risk of adult end-stage renal disease. N Engl J Med 2018; 378:428−438].

March 2018 (Vol. 10, Number 3)