kidney disease can increase the risk of end-stage
kidney disease (ESRD)
in adulthood, even
after complete healing
- Adults from
Israel appeared to be at an increased risk for end-stage renal disease
(ESRD) if they suffered from kidney disease in childhood.
- The increased
risk appears to be present even after apparent complete resolution of the
condition in childhood.
- Children with
childhood kidney disease should therefore be regularly monitored so that
adequate measures can be taken to prevent ESRD.
. This was the finding of a
study from Israel and published in the New
England Journal of Medicine
The scientists involved
in the study obtained information of childhood kidney diseases by sifting
through the medical records of more than 1.5 million adolescents who were
recruited for compulsory military service in Israel between the years 1967 and
1997. The average age of the adolescents included in the study was 17.7 years.
Subsequent information of the occurrence of ESRD in adulthood was obtained from
the Israeli ESRD registry.
‘Children who suffered from kidney disease in childhood appear to be at a higher risk for end-stage renal disease (ESRD) during adulthood, even after apparent complete resolution of the condition during childhood.’
The scientists noted
study thus implies that it is important to monitor the kidney function in
individuals who suffered from kidney disease at a young age, even if they had
an apparent complete recovery
- The adolescents
who suffered from childhood kidney disease had normal kidney function and
blood pressure measurement at the time of recruitment into the military.
- A total of 2490
recruits suffered from ESRD in later life. Individuals who had a kidney disease in childhood were at a higher
risk of ESRD than those without a documented childhood kidney disease. The
increased risk was despite the fact that the kidney problem had resolved
in childhood. The ESRD also developed at an earlier age in these
- The increased risk for ESRD was independent of the type
of childhood kidney condition. The
childhood kidney diseases considered in the study included congenital
malformations of the kidney and the urinary tract, infection (pyelonephritis
or glomerular diseases.)
. The scientists suggest that children with
kidney disease may have lesser number of nephrons or filtering units of the
kidney at birth. Also, the injury to the kidney in the early days of life may
result in some scarring, which may go undetected and contribute to ESRD in later
editorial in the same journal points out a number of missing links in the
study. These include details of the childhood kidney disease in terms of
symptoms, the age of diagnosis of the kidney disease, treatment that the
individuals underwent, or details of imaging studies to confirm the resolution
of the kidney disease (if they were done). The study population mainly included
Israeli Jewish men, and it is not clear if the results can be extrapolated to
women or other populations.
Childhood Kidney Diseases
Kidney diseases in
children can affect the growth and development of the children. They can be
acute, and if not resolved, can progress into a chronic form.
can also be caused due to
- Birth defects like kidney dysplasia or absent kidney, inherited
conditions like polycystic
kidney disease and Alport syndrome.
- Infections can also result in
conditions like hemolytic uremic syndrome and acute post-streptococcal
glomerulonephritis, nephrotic syndrome.
- Generalized disorders like diabetes and systemic lupus erythematosus or trauma
to the kidney due to injury, dehydration, surgery or reflux of urine into
treatment of the kidney disease, other issues like school attendance,
involvement in sports, playing with friends and getting a job at a later date
should also be taken care of in this population. References :
- Ingelfinger JR. A Disturbing Legacy of Childhood Kidney Disease. N Engl J Med 2018; 378:470-471. DOI: 10.1056/NEJMe1716499
- Calderon-Margalit R et al. History of Childhood Kidney Disease and Risk of Adult End-Stage Renal Disease. History of Childhood Kidney Disease and Risk of Adult End-Stage Renal Disease. N Engl J Med 2018; 378:428-438DOI: 10.1056/NEJMoa1700993
- Kidney Disease in Children - (https://www.niddk.nih.gov/health-information/kidney-disease/children)
- Caring for a Child with Kidney Disease - (https://www.niddk.nih.gov/health-information/kidney-disease/children/caring-child-kidney-disease)