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

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Body surface area-based kidney length percentiles misdiagnose small kidneys in children with overweight/obesity
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2022-09-02 , DOI: 10.1007/s00467-022-05718-8
Pierluigi Marzuillo ₁ , Gemma Carreras-Badosa ₂ , José-María Martínez-Calcerrada ₃ , Stefano Guarino ₁ , Pier Luigi Palma ₁ , Delfina Petrone ₁ , Emanuele Miraglia Del Giudice ₁ , Judit Bassols ₃ , Abel López-Bermejo _{2,

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Affiliation

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 < 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.

Graphical abstract

中文翻译：

基于体表面积的肾脏长度百分位数误诊超重/肥胖儿童的小肾脏

背景

我们评估了基于身高、年龄和体表面积 (BSA) 的肾脏长度 (KL) 百分位数在识别至少一个小肾脏（KL < 3 rd）和预测^肾小球滤过率降低方面的诊断性能有和没有超重 (OW)/肥胖 (OB) 的儿童的比率 (eGFR) 和/或血压升高 (BP)。

方法

在这项横断面研究中，初级保健机构招募了 744 名外表健康的儿童（平均年龄 8.3 岁）。收集临床数据，测量血清肌酐和 KL。计算了基于身高、年龄和 BSA 的 KL 百分位数，并通过逻辑回归探讨了每个受试者至少一个小肾脏与 eGFR 降低和/或血压升高之间的关联。

结果

744 名受试者中有 257 名 (34.5%) 为 OW/OB，127 名 (17.1%) 的 eGFR 降低或血压升高。在对 OW/OB 儿童的单独分析中，与基于身高和年龄的 KL 百分位数相比，基于 BSA 计算的 KL 百分位数较低。因此，与其他百分位数相比，基于 BSA 评估 KL 百分位数时，小肾的患病率明显更高。在逻辑回归分析中，仅当使用基于身高的 KL 百分位数时，小肾脏才与 eGFR 降低和/或血压升高显着相关。根据 BSA 的理想体重 (iBSA) 的 KL 百分位数与基于身高的百分位数相比表现出相似的性能。在体重正常的儿童中，不同百分位数的诊断性能没有差异。