Congenital Risk Factors for Chronic Kidney Disease in Patients With Persistent Cloaca: Results From a Nationwide Survey in Japan

IF 2.5 2区医学 Q1 PEDIATRICS Journal of pediatric surgery Pub Date : 2025-02-01 Epub Date: 2024-07-17 DOI:10.1016/j.jpedsurg.2024.07.015

Ayaka Nagano , Toshio Harumatsu , Koshiro Sugita , Masakazu Murakami , Keisuke Yano , Shun Onishi , Takafumi Kawano , Satoshi Ieiri , Masayuki Kubota

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Abstract

Background

We conducted a nationwide survey of persistent cloaca (PC) to investigate the renal function outcomes and factors affecting chronic kidney disease (CKD) in patients with PC.

Method

Information from 466 patients with PC was obtained via a questionnaire in this study. The 290 patients (62.2%) with renal function data were classified into 2 groups based on their estimated glomerular filtration rate: advanced CKD group (<30 mL/min/1.73 m² [or post-renal replacement therapy]) and non-advanced CKD group (≥30 mL/min/1.73 m²). Univariate and multivariate analyses were performed to identify risk factors for CKD that may affect the renal function, including renal and urinary tract malformations, associated anomalies, and urinary tract treatment. The advanced CKD group was divided into two groups based on age to evaluate age-related differences (younger- and older-age CKD groups).

Results

A regression analysis revealed that congenital renal malformations (odds ratio [OR]: 14.06, 95% confidence interval [CI]:3.07–131.65, p < 0.0001), urinary tract obstruction (OR:4.28, 95%CI:1.12–24.23, p < 0.05), and sacral agenesis (OR:4.54, 95% CI:0.84–30.67, p < 0.05) were significantly associated with advanced CKD. In the univariate analysis of factors affecting the renal prognosis, clean intermittent catheterization (CIC) (OR:4.18, 95%CI:1.21–16.45, p = 0.015), vesicostomy (OR:3.65, 95%CI:1.11–12.98, p = 0.019), and surgery for vesicoureteral reflux (OR:5.43, 95%CI:1.41–22.73, p = 0.006) were significantly associated with advanced CKD. Based on the univariate analysis, hydrometrocolpos was significantly more prevalent in the older-age CKD group compared to the younger-age CKD group (p < 0.05).

Conclusion

CKD development in patients with PC is influenced by a complex interplay of factors, including renal malformations and neurogenic bladder dysfunction due to spinal anomalies.

Level of Evidence

III (Study of Diagnostic Test, Study of nonconsecutive patients, and/or without a universally applied “gold” standard).

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顽固性泄殖腔患者患慢性肾病的先天性风险因素：日本全国性调查的结果

背景：我们在全国范围内对持续性泄殖腔（PC）患者进行了调查，以研究PC患者的肾功能结局和影响慢性肾脏疾病（CKD）的因素。方法对466例PC患者进行问卷调查。290例（62.2%）有肾功能数据的患者根据肾小球滤过率分为2组：晚期CKD组（≤30 mL/min/1.73 m2[或肾替代治疗后]）和非晚期CKD组（≥30 mL/min/1.73 m2）。进行单因素和多因素分析，以确定CKD可能影响肾功能的危险因素，包括肾脏和尿路畸形、相关异常和尿路治疗。晚期CKD组根据年龄分为两组，以评估年龄相关差异（年轻和老年CKD组）。结果回归分析显示先天性肾脏畸形(优势比[OR]: 14.06, 95%可信区间[CI]: 3.07-131.65, p <；0.0001)，尿路梗阻(OR:4.28, 95%CI: 1.12-24.23, p <；0.05)，骶骨发育不全(OR:4.54, 95% CI: 0.84-30.67, p <；0.05)与晚期CKD显著相关。在影响肾脏预后因素的单因素分析中，清洁间歇置管（CIC）（OR:4.18, 95%CI: 1.21-16.45, p = 0.015）、膀胱造口术（OR:3.65, 95%CI: 1.11-12.98, p = 0.019）和膀胱输尿管反流手术（OR:5.43, 95%CI: 1.41-22.73, p = 0.006）与晚期CKD显著相关。基于单变量分析，老年CKD组与年轻CKD组相比，水性结肠明显更普遍(p <；0.05)。结论PC患者ckd的发展受多种因素的复杂相互作用影响，包括肾畸形和脊柱异常引起的神经源性膀胱功能障碍。证据水平ii（诊断测试的研究，非连续患者的研究，和/或没有普遍应用的“金”标准）。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.