RESUMO
OBJECTIVE: A national registry of children with Chronic Kidney Disease (CKD) was started in 2007. We analize it to know the incidence, prevalence, demography, etiology, clinical and metabolic state of the children with CKD, in stages 2-5 pre-dialysis, and complying with the K/DOQI guidelines. MATERIAL AND METHODS: In the REPIR II 46 centers distributed throughout the Spanish geography are involved. To classify and evaluate comorbidity of the disease, the Clinical Practice Guidelines K/DOQI criteria are used. Each center provides an annual developmental data of each patient which is recorded in a On-line database. INCLUSION CRITERIA: patients with CKD who are between stage 2 and 5 in predialysis and which are 18 years old or less. RESULTS: In 2008 there were 605 patients with CKD, the incidence was 8.66 per million of pediatric population (pmpp) and the prevalence was 71.06 pmpp. Structural anomalies was the primary cause of CKD (59% of the cases). The percentage of glomerular diseases was very low (3%). There was a clear predominance of males (66%) and Caucasian race (88%). Mean GFR was 52 ± 2 ml/min/1.73 m(2) with 82% of them in stage 2 and 3. The prevalence of anaemia was 30%. Only 19% of our patients had hypertension and only 17% of them fulfilled the 4 recommendations for calcium-phosphorus metabolism of K/DOQI Guidelines. Mean height Z-Score was -1.03 ± 2. There were 136 patients (25%) who had a mean height Z-Score of size < or = -1.88. In a multivariate logistic regression analysis only a meaningful relationship between age and height was identified. All the children under 2 years old had a 40% higher probability of having a short height (OR = 1.40; P < 0.01). The percentage of malnutrition (BMI Z-Score < or = 1.88) was 7%, mostly in the 0-2 years old group. CONCLUSIONS: We report the first study that performs a prospective analysis of incidence, prevalence, etiology and comorbidity of CKD in the pediatric population of the Spanish State. Given the short life of this record the data presented is provisional and may suffer meaningful changes in coming years.
Assuntos
Nefropatias/epidemiologia , Sistema de Registros , Adolescente , Antropometria , Criança , Pré-Escolar , Doença Crônica , Comorbidade , Feminino , Taxa de Filtração Glomerular , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/etiologia , Humanos , Incidência , Lactente , Nefropatias/complicações , Testes de Função Renal , Masculino , Guias de Prática Clínica como Assunto , Prevalência , Estudos Prospectivos , Distribuição por Sexo , Espanha/epidemiologiaRESUMO
Objetivo: Analizar los datos epidemiológicos, clínicos y analíticos, así como la curva de supervivencia renal y los factores pronósticos a corto y a largo plazo de niños con nefropatía de Schönlein-Henoch (NSH).Material y método: Estudio clínico de cohorte retrospectivo analítico. Se revisan las historias clínicas de 100 niños diagnosticados de NSH en el HIU La Fe entre 1975 y 2006.Resultados: La manifestación nefrológica más frecuente fue hematuria con proteinuria no nefrótica. El 35% de pacientes fueron biopsiados. La histología más frecuente fue la proliferación mesangial (46%). Los estadios clínicos al diagnóstico fueron Estadio B: 63%, Estadio C: 33%; Estadio D: 4%. Estadios clínicos a los 5 años: Estadio A: 49%, Estadio B: 27%,Estadio C: 0% y Estadio D: 5%. Trasplante renal: 5%. Curva de supervivencia renal (Kaplan Meier) a 5 años: 95%. Factores pronósticos: En el análisis univariante se evidencia que tanto a corto como a largo plazo los factores de mal pronóstico renal fueron la edad superior a 8 años al debut, el número de brotes de púrpura superior a 4 y la presencia de una estadio VI en la histología. El análisis multivariante muestra que a corto plazo únicamente el número de brotes es considerado factor pronóstico. Conclusión: Se pueden considerar como factores pronósticos, tanto a corto como a largo plazo, la edad al inicio de la enfermedad renal, el nº de brotes y la alteración histológica. Sin embargo, en el análisis multivariante únicamente el nº de brotes constituye un factor pronóstico a corto plaz (AU)
Objective: To analyze epidemiological, clinical and laboratory data, renal survival curve and short-term (2 years) and long-term(5 years) prognostic factors in children with nephropathy secondary to Henoch-Schönlein purpura (HSP).Materials and methods: Retrospective analitic cohort study. Clinical records of 100 children diagnosed with HSP at HIU La Fe from 1975-2006 were reviewed. Statistical analysis was by univariate and multivariate analysis. Results: In 67% of cases, nephropathy coincided with onset of the disease and most commonly manifested hematuria with nonnephrotic proteinuria. 35% of patients were biopsied. The most common histology was mesangial proliferation (46%). Clinical stages at diagnosis were stage B: 63%, stage C: 33%;stage D: 4%. Mean follow-up was 5.25 ± 0.76 years. Renal data at 5 years: Clinical stages: stage A: 49%, stage B: 27%, stage C:0%, and stage D: 5%. Renal transplant: 5%. Renal survival curve(Kaplan-Meier) at 5 years: 95%. Prognostic factors: the univariate analysis showed that the prognostic factors of poor renal prognosis in both the short and long-term were age greater than 8 years, number of purpura relapses greater than 4 and presence of stage VI histology. The multivariate analysis showed that only the number of relapses was a short-term prognostic factor. Conclusion: 1) The clinical and laboratory data reviewed were similar to those reported in the literature. 2) The renal survival curve at 5 years was 95%. 3) Age, number of relapses and histology were prognostic factors. 4) The multivariate analysis showed that only the number of relapses was a short-term prognostic factor (AU)
Assuntos
Humanos , Masculino , Feminino , Criança , Vasculite por IgA/complicações , Nefropatias/complicações , Progressão da Doença , Estudos Retrospectivos , Recidiva/prevenção & controle , Fatores de Risco , Hematúria/etiologiaRESUMO
OBJECTIVE: To analyze epidemiological, clinical and laboratory data, renal survival curve and short-term (2 years) and long-term (5 years) prognostic factors in children with nephropathy secondary to Henoch-Schönlein purpura (HSP). MATERIALS AND METHODS: Retrospective analitic cohort study. Clinical records of 100 children diagnosed with HSP at H.I.U. La Fe from 1975-2006 were reviewed. Statistical analysis was by univariate and multivariate analysis. RESULTS: In 67% of cases, nephropathy coincided with onset of the disease and most commonly manifested hematuria with nonnephrotic proteinuria. 35% of patients were biopsied. The most common histology was mesangial proliferation (46%). Clinical stages at diagnosis were stage B: 63%, stage C: 33%; stage D: 4%. Mean follow-up was 5.25 +/- 0.76 years. Renal data at 5 years: Clinical stages: stage A: 49%, stage B: 27%, stage C: 0%, and stage D: 5%. Renal transplant: 5%. Renal survival curve (Kaplan-Meier) at 5 years: 95%. Prognostic factors: The univariate analysis showed that the prognostic factors of poor renal prognosis in both the short and long-term were age greater than 8 years, number of purpura relapses greater than 4 and presence of stage VI histology. The multivariate analysis showed that only the number of relapses was a short-term prognostic factor. CONCLUSION: 1) The clinical and laboratory data reviewed were similar to those reported in the literature. 2) The renal survival curve at 5 years was 95%. 3) Age, number of relapses and histology were prognostic factors. 4) The multivariate analysis showed that only the number of relapses was a short-term prognostic factor.
