Renal size and cardiovascular risk in prepubertal children

Renal size is an important parameter for the evaluation and diagnosis of kidney disease and has been associated with several cardiovascular risk factors in patients with kidney failure. These results are however discordant and studies in healthy children are lacking. We aimed to study the association between renal size (length and volume) and cardiovascular risk parameters in healthy children. Clinical, analytical and ultrasound parameters [renal length, renal volume, perirenal fat and carotid intima-media thickness (cIMT)] were determined in 515 healthy prepubertal children (176 lean, 208 overweight and 131 obese). Renal length and volume associated significantly and positively with several anthropometric and cardiovascular risk parameters including cIMT and systolic blood pressure (SBP) (all p < 0.001). Renal length and volume associated with cIMT and SBP in all study subgroups, but these associations were predominant in obese children, in whom these associations were independent after adjusting for age, gender and BSA (all p < 0.05). In multivariate analyses in the study subjects as a whole, renal length was an independent predictor of cIMT (β = 0.310, p < 0.0001) and SBP (β = 0.116, p = 0.03). Renal size associates with cIMT and SBP, independent of other well-established cardiovascular risk factors, and may represent helpful parameters for the early assessment of cardiovascular risk in children

L’àcid úric, el greix perirenal i la mida renal com a nous marcadors de risc cardiovascular en població pediàtrica sana

Despite notable advances in health promotion over the past decades, cardiovascular disease remains the leading cause of death worldwide, with obesity being a rising contributor of it. Cardiovascular risk factors appear in early life, and their detection in the pediatric age is really important to identify the risk population and to develop new primary prevention strategies. We aimed to identify novel markers than can be easily assessed and used in the clinical evaluation and early prevention of cardiovascular disease in the pediatric population. Specifically, we have studied the relationship of uric acid, perirenal fat and kidney size with carotid intima-media thickness (cIMT; a marker of subclinical atherosclerosis) and classical cardiovascular risk factors in a cohort of 702 healthy prepubertal children with and without overweight and obesity. Our results show that 1) uric acid levels are associated with several cardiovascular risk factors and are independent predictors of cIMT, especially in children with higher body mass index (BMI) and higher preperitoneal fat; 2) perirenal fat is the main abdominal fat depot associated with cIMT, especially in overweight and obese children; 3) renal size (length and volume) also are associated with several cardiovascular risk factors and showed independent associations with cIMT and systolic blood pressure (SBP) in obese children. In conclusion, serum uric acid levels, perirenal fat, and kidney size are associated with various cardiovascular risk factors, especially in children with overweight and obesity, and may thus represent useful parameters for assessing cardiovascular risk and the onset of atherosclerotic disease in healthy childrenMalgrat els notables avenços de les últimes dècades en la promoció de la salut, la malaltia cardiovascular segueix essent la principal causa de mort a tot el món, i l’obesitat hi contribueix de manera creixent. Els factors de risc cardiovascular (RCV) apareixen en etapes primerenques de la vida i la seva detecció en l’edat pediàtrica és important per tal d’identificar la població de risc i poder desenvolupar estratègies de prevenció. L’objectiu principal d’aquest treball és identificar nous marcadors de fàcil determinació i aplicació que puguin ajudar a l’avaluació clínica i a la prevenció de malalties cardiovasculars en la població pediàtrica. Concretament s’estudia la relació de l’àcid úric, el greix perirenal i la mida renal amb el gruix íntima-mitjana carotídia (GIMc; marcador d’aterosclerosis subclínica) i amb factors de risc cardiovascular clàssics en una cohort de 702 nens prepuberals sans amb diversos graus d’obesitat. Els resultats mostren que 1) els nivells d’àcid úric s’associen amb diversos factors de risc cardiovasculars clàssics i son predictors independents del GIMc, especialment en nens amb major índex de massa corporal (IMC) i major greix preperitoneal; 2) el greix perirenal és el dipòsit de greix abdominal que més s’associa amb el GIMc, especialment en nens amb sobrepès i obesitat; 3) la mida renal (longitud i volum) també s’associa positivament amb diversos factors de risc cardiovascular i mostra associacions independents amb el GIMc i la TAS en nens amb obesitat. Podem concloure que els nivells d’àcid úric, el greix perirenal i la mida renal s’associen amb diversos factors de risc cardiovascular, especialment en nens amb sobrepès i obesitat, i per tant, poden representar un paràmetre útil per avaluar el risc cardiovascular i l’aparició de malaltia arterioscleròtica en la població pediàtrica sanaPrograma de Doctorat en Biologia Molecular, Biomedicina i Salu

Body surface area-based kidney length percentiles misdiagnose small kidneys in children with overweight/obesity

Background We evaluated the diagnostic performance of height-, age- and body surface area (BSA)-based kidney length (KL) percentiles in the identification of at least one small kidney (KL &lt; 3(rd)) and in the prediction of reduced estimated glomerular filtration rate (eGFR) and/or elevated blood pressure (BP) in children with and without overweight (OW)/obesity(OB).Methods In this cross-sectional study, 744 apparently healthy children (mean age 8.3 years) were recruited in a primary care setting. Clinical data were collected, and serum creatinine and KL were measured. Height-, age- and BSA-based percentiles of KL were calculated and the association of at least one small kidney per subject with reduced eGFR and/or elevated BP was explored by logistic regression.Results Two hundred fifty-seven out of seven hundred forty-four (34.5%) subjects were OW/OB and 127 (17.1%) had reduced eGFR or elevated BP. In separate analyses in children with OW/OB, the KL percentiles calculated on the basis of BSA were lower compared with height- and age-based KL percentiles. Consequently, the prevalence of a small kidney was significantly higher when evaluating percentiles of KL based on BSA compared with other percentiles. In logistic regression analysis, a small kidney was significantly associated with reduced eGFR and/or elevated BP only when using height-based KL percentiles. The KL percentiles according to BSA for the ideal weight (iBSA) showed similar performance compared with height-based percentiles. No differences in the diagnostic performance of different percentiles were found in children with normal weight.Conclusions BSA-based percentiles underestimate KL in children with OW/OB. In these subjects, the use of height-based or iBSA-based percentiles should be preferred

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Editors: v. 1, 6. ed., Santiago Chamorro Piñero; v. 1, 7. ed., v. 5, 6.-7. ed., Pascual Marín Pérez; v. 2, 6.-7. ed., v. 7, 6.-7. ed., Francisco Bonet Ramon; v. 3, 7. ed., Julio Calvillo Martínez de Arenaza; v. 4, 6.-7. ed., José María Pou de Avilés; v. 6, 7. ed., Tomás Ogáyar y Ayllón; v. 6, 8. ed., Luis Martínez Calcerrada; v. 8, 5.-6. ed., Miguel Moreno Mocholi; v. 9, 5. ed., José M. Castan Vazquez; v. 10, 5. ed., José M. Bloch; v. 11, 5. ed., Francisco Tellez y Miguélez; v. 12, 5. ed., Lino Rodríguez-Arias BustamantePublisher variesSet contains various editions of each volumeMode of access: Internet