Background

Children with chronic kidney disease (CKD) are at risk for abnormalities in pubertal development. We aimed to describe the timing of pubertal onset by luteinizing hormone (LH) levels and the association between hormonal onset of puberty with changes in GFR.

Methods

Data from the Chronic Kidney Disease in Children (CKiD) study were collected prospectively. GFR was estimated at annual visits and measured by iohexol clearance every other year. LH was measured from stored repository serum samples in a nested sample of 124 participants. Hormonal onset of puberty was defined as LH level greater than or equal to 0.3 IU/L. A mixed effects model with random intercepts and slopes was used to compare the slope of decline of GFR before and after hormonal onset of puberty. The model was adjusted for age, glomerular disease diagnosis, baseline proteinuria on the log scale, and BMI.

Results

Median age at hormonal onset of puberty was 9.9 years (IQR 8.1, 11.9) in girls and 10.2 years (IQR 9.2, 11.0) in boys. The mixed effects model showed faster decline in both estimated GFR and measured GFR in boys after hormonal onset of puberty (p < 0.001), and a similar but attenuated accelerated estimated GFR decline was observed for girls with no difference for measured GFR.

Conclusions

LH levels in the post-pubertal range were observed prior to clinical manifestations of puberty in children with CKD. Hormonal onset of puberty was associated with faster decline in GFR, particularly among boys with CKD.

Graphical abstract

中文翻译：

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慢性肾病儿童青春期黄体生成素水平及其与肾小球滤过率变化的关系

背景

患有慢性肾脏病 (CKD) 的儿童面临青春期发育异常的风险。我们的目的是通过黄体生成素 (LH) 水平来描述青春期开始的时间以及青春期激素开始与 GFR 变化之间的关联。

方法

前瞻性收集儿童慢性肾脏病 (CKiD) 研究的数据。GFR 是在每年就诊时估算的，并每隔一年通过碘海醇清除率进行测量。LH 是从 124 名参与者的嵌套样本中储存的储存库血清样本中测量的。青春期荷尔蒙开始定义为 LH 水平大于或等于 0.3 IU/L。使用具有随机截距和斜率的混合效应模型来比较青春期激素开始之前和之后 GFR 下降的斜率。该模型根据年龄、肾小球疾病诊断、对数刻度基线蛋白尿和体重指数进行了调整。

结果

女孩荷尔蒙青春期开始的中位年龄为 9.9 岁（IQR 8.1，11.9），男孩为 10.2 岁（IQR 9.2，11.0）。混合效应模型显示，青春期荷尔蒙开始后，男孩的估计 GFR 和测量 GFR 均下降更快 ( p  < 0.001)，而女孩观察到类似但减弱的估计 GFR 加速下降，测量 GFR 没有差异。

结论

在 CKD 儿童青春期临床表现之前观察青春期后范围内的 LH 水平。青春期荷尔蒙的开始与 GFR 更快下降有关，特别是在患有 CKD 的男孩中。

图形概要