The Association Between Markers of Inflammation and the Progression of Chronic Kidney Disease in Children with Congenital Anomalies of the Kidney and Urinary Tract (CAKUT).

Abstract

Introduction: Congenital anomalies of the kidney and urinary tract (CAKUT) are a leading cause of chronic kidney disease (CKD) in children. Despite the advancements in prenatal diagnosis and early management, the need for biomarkers for early prediction and diagnosis of CKD in those children is emerging.Aimed of the study: To evaluate the efficacy of plasma Kidney injury molecule-1 (KIM-1) and tumor necrosis factor-alpha (TNF-α) in early prediction of CKD progression in children with CAKUT.Methods: Across-sectional controlled study included 60 children with CAKUT and CKD (stages 2, 3, and 4) and 60 healthy children as a control group. All included children were subjected to a comprehensive history taking, clinical examination, and investigation, including blood urea, serum creatinine, CBC, GFR calculation, KIM-1, and TNF-α plasma levels. Results: TNF-α and KIM-1 levels were significantly higher in patients than controls (p<0.001 for both). Also, Kim-1 and TNF-α levels were significantly higher in the severe CKD group than in non-severe CKD (p <0.001 and 0.005, respectively). Both markers were significantly positively correlated to serum creatinine and GFR. The receiver operating characteristic analysis demonstrated that both TNF-α and KIM-1 could predict early CKD even prior to the increase in creatinine levels. Furthermore, they can also predict the progression of CKD when there are slight changes in creatinine levels.Conclusions: TNF-α and KIM-1 could predict the progressiont of early CKD even prior to the increase in creatinine levels. They can also predict CKD progression when there are slight changes in creatinine levels.