TY  - JOUR
TI  - Identification of young adults at risk of accelerated kidney function loss in an area affected by Mesoamerican nephropathy
AV  - public
Y1  - 2019/01/16/
VL  - 20
N1  - Copyright © The Author(s) 2019.This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
ID  - discovery10064686
N2  - Background: After two-years of follow-up of 263 apparently healthy 18- to 30-year-old men in communities affected by Mesoamerican nephropathy (MeN), we identified three distinct case groups: a subgroup with (i) established renal dysfunction (case-group 1); individuals with (ii) a rapid decline in kidney function (case-group 2); and individuals with (iii) stable kidney function (non-cases). This paper investigates whether local tests are potentially useful for the timely identification of these case groups. / Methods: Creatinine levels were measured in local laboratories every six months for two years. Aliquots were sent to a centralized laboratory for measurements of cystatin C and creatinine levels. We investigated agreement between the locally and centrally measured creatinine-based Chronic Kidney disease Epidemiology Collaboration (CKD-EPI) equation for estimating the Glomerular Filtration Rate (eGFR). A logistic regression analysis was used to assess predictive factors for case groups 1 and 2 compared to non-cases. Predictive variables were locally measured eGFR, and urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels. The discrimination performance of the model was assessed using the area under the receiver operating characteristic curve (AUC). / Results: Considerable variation in local eGFR measurements was observed. The prediction model for case-group 1 included baseline kidney function and with or without uNGAL (AUC?=?0.98, 95% confidence interval (CI), 0.91?1.00). The prediction model for case-group 2 also required eGFRScr at six and twelve months after baseline, with or without uNGAL levels (AUC?=?0.88; 95% CI 0.80?0.99). / Conclusions: Established renal dysfunction was detected at a single time point using local measurements and uNGAL. For the detection of a rapid decline in kidney function over time, at least 2 more measurements at six and twelve months are needed.
SN  - 1471-2369
UR  - https://doi.org/10.1186/s12882-018-1193-x
PB  - BioMed Central
JF  - BMC Nephrology
KW  - Mesoamerican nephropathy
KW  -  Chronic kidney disease of unknown aetiology
KW  -  Prediction
KW  -  Kidney function status
KW  -  Serum creatinine
KW  -  uNGAL
KW  -  ROC
KW  -  Nicaragua
A1  - Gonzalez-Quiroz, M
A1  - Smpokou, E-T
A1  - Pearce, N
A1  - Caplin, B
A1  - Nitsch, D
ER  -