Background

Congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of childhood chronic kidney disease (CKD). We hypothesized that hypertension varies across CAKUT categories and increases the risk of CKD.

Methods

This was a retrospective cohort study and included cases with a multicystic dysplastic kidney (MCDK, n = 81), unilateral kidney agenesis (UKA, n = 47), kidney hypoplasia (KH, n = 130), and posterior urethral valves (PUV, n = 75). Hypertension was defined as systolic or diastolic blood pressure ≥ 95^th percentile for age, sex and height, and CKD as an estimated glomerular filtration rate < 60 ml/min/1.73 m², both at 2 consecutive clinic visits at least 3 months apart.

Results

Sixty-two (19%) out of 333 cases developed hypertension, with significant difference according to CAKUT type. Patients with smaller kidney size (7.7 vs. 8.3, p = 0.045), kidney anomalies in addition to the primary diagnosis (aCAKUT) (53 vs. 38%, p = 0.03), proteinuria (46 vs. 12%, p < 0.001), and CKD (51 vs. 23%, p < 0.001) were more likely to develop hypertension. When adjusted for kidney size, the diagnoses of PUV (OR 10.9, 95%CI 3.0, 40.5), UKA (OR 6.4, 95%CI 1.6, 24.9) and KH (OR 4.2, 95%CI 1.1, 16.1), and aCAKUT (OR 2.1, 95%CI 1.2, 3.9) were independent risk factors for hypertension. Hypertension increased the risk of developing CKD by twofold (HR 1.9, 95%CI 1.19, 2.94).

Conclusion

Hypertension is common in children with CAKUT and increases the risk of CKD. These findings will aid in the development of a standardized clinical pathway for the care of hypertensive children with CAKUT.

Graphical abstract

中文翻译：

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先天性肾脏和泌尿道异常儿童的高血压

背景

肾脏和尿路先天性异常 (CAKUT) 是儿童慢性肾脏病 (CKD) 的最常见原因。我们假设高血压在不同 CAKUT 类别中存在差异，并且会增加 CKD 的风险。

方法

这是一项回顾性队列研究，包括多囊性发育不良肾 (MCDK，n  = 81)、单侧肾发育不全 (UKA，n  = 47)、肾脏发育不全 (KH，n  = 130) 和后尿道瓣膜 (PUV，n  = 75)。高血压的定义为年龄、性别和身高的收缩压或舒张压≥第95个^百分位数，CKD的定义为估计肾小球滤过率<60 ml/min/1.73 m ²，两者均在相隔至少3个月的连续2次就诊中进行。

结果

333 例中有 62 例（19%）出现高血压，根据 CAKUT 类型有显着差异。肾脏尺寸较小的患者（7.7 vs. 8.3，p  = 0.045）、除初步诊断 (aCAKUT) 外还存在肾脏异常（53 vs. 38%，p  = 0.03）、蛋白尿（46 vs. 12%，p  < 0.001） ）和 CKD（51% vs. 23%，p  < 0.001）更有可能患高血压。根据肾脏大小进行调整后，PUV（OR 10.9，95%CI 3.0，40.5）、UKA（OR 6.4，95%CI 1.6，24.9）和 KH（OR 4.2，95%CI 1.1，16.1）和 aCAKUT 的诊断（OR 2.1，95%CI 1.2，3.9）是高血压的独立危险因素。高血压使患 CKD 的风险增加两倍（HR 1.9，95% CI 1.19，2.94）。

结论

高血压在患有 CAKUT 的儿童中很常见，并会增加 CKD 的风险。这些发现将有助于制定用于 CAKUT 治疗高血压儿童的标准化临床路径。

图形概要