BACKGROUND:The long-term risk associated with childhood kidney disease that had not progressed to chronic kidney disease in childhood is unclear. We aimed to estimate the risk of future end-stage renal disease (ESRD) among adolescents who had normal renal function and a history of childhood kidney disease. METHODS:We conducted a nationwide cohort study of 1,521,501 Israeli adolescents who were examined before compulsory military service in 1967 through 1997; data were linked to the Israeli ESRD-registry. Kidney diseases in childhood included congenital anomalies of the kidney and urinary tract (CAKUT), pyelonephritis, and glomerular disease; all participants included in the analysis had normal renal function and no hypertension in adolescence. Cox proportional-hazards models were used to estimate the hazard ratio for ESRD associated with a history of kidney disease. RESULTS:During 30 years of follow-up, ESRD developed in 2490 persons. A history of any childhood kidney disease was associated with a hazard ratio for ESRD of 4.19 (95% [CI], 3.52-4.99). The associations between each diagnosis in childhood (CAKUT, pyelonephritis, and glomerular disease) and the risk of ESRD in adulthood were similar in magnitude (multivariable-adjusted hazard ratios of 5.19 [95% CI, 3.41-7.90], 4.03 [3.16-5.14], and 3.85 [2.77-5.36], respectively). A history of kidney disease in childhood was associated with younger age at the onset of ESRD. CONCLUSIONS:A history of kidney disease in childhood, even if renal function was normal in adolescence, was associated with a significantly increased risk of ESRD, which suggests that kidney injury or structural abnormality in childhood has long-term consequences.
(NEJM 2018)
