Development of a risk score for earlier diagnosis of chronic kidney disease in children.

OBJECTIVE: To develop a clinical score for the early identification of chronic kidney disease (CKD) in children and adolescents. The early diagnosis of CKD in childhood allows the adoption of measures to slow the progression of the disease, thereby reducing morbidity and mortality. Nevertheless, the diagnosis is often made too late for proper patient management. STUDY DESIGN: We preformed a case-control study of a multicenter Brazilian sample of 752 pediatric patients; the study cases (n = 376) were CKD patients with a median estimated GFR of 37 (IQR = 22 to 57) ml/min/1.73 m2. The control group (n = 376) comprised age-, gender- and center-matched children who were followed for nonrenal diseases. Potential risk factors were investigated through a standard questionnaire that included symptoms, medical history, and a clinical examination. Two multivariable models (A and B) were fitted to assess predictors of the diagnosis of CKD. RESULTS: In model A, 9 variables were associated with CKD diagnosis: antenatal ultrasound with urinary malformation, recurrent urinary tract infection, polyuria, abnormal urine stream, nocturia, growth curve flattening, history of hypertension, foamy urine and edema (c-statistic = 0.938). Model B had the same variables as model A, except for the addition of the history of admission during the neonatal period and the exclusion of antenatal ultrasound variables (c-statistic = 0.927). CONCLUSIONS: The present scores may serve as a warning sign for CKD diagnosis in children among professionals working in the primary care setting where the symptoms associated with a risk of CKD may be overlooked.

Signs and symptoms of developmental abnormalities of the genitourinary tract.

OBJECTIVE: The abnormalities of the genitourinary tract development are the leading cause of chronic kidney disease (CKD) in children. The diagnosis of this disease in Brazil is late and incomplete, which results in increased morbidity and mortality in this age group. Early diagnosis of this condition is the prerogative of generalist pediatricians, and the aim of this study was to review the clinical signs and symptoms associated with developmental abnormalities of the genitourinary tract. DATA SOURCES: Based on the description of a symbolic clinical case, the authors conducted a non-systematic review of medical literature. DATA SYNTHESIS: The results suggest that the following data should be used as a warning for early diagnosis of affected children: (a) combined urinary tract abnormalities (chromosomal abnormalities; sequence of malformations [VACTERLand Prune-Belly]; and musculoskeletal, digestive tract, heart, and nervous system malformations); (b) previous history (congenital anomalies of the kidney and urinary tract [CAKUT] in the family, low birth weight, and oligoamnios); (c) clinical signs (polyuria/nocturia, urinary tract infection, systemic arterial hypertension, failure to thrive, weak urinary stream, difficulty to start urination, distended bladder, non-monosymptomatic enuresis, urinary/urge incontinence, and bowel and bladder dysfunction); and (d) pre- and postnatal ultrasonographic alterations (increased anteroposterior diameter of the renal pelvis, mainly in the third trimester of pregnancy; single kidney; hydronephrosis associated with other abnormalities; and hydronephrosis with parenchymal involvement in the post-neonatal assessment). CONCLUSION: The suggestions shown here can help the pediatrician to establish clinical hypotheses for the early diagnosis of developmental abnormalities of the genitourinary tract without resorting to expensive and invasive procedures.

Signs and symptoms of developmental abnormalities of the genitourinary tract / Sinais e sintomas das anormalidades do desenvolvimento do trato geniturinário

Abstract Objective: The abnormalities of the genitourinary tract development are the leading cause of chronic kidney disease (CKD) in children. The diagnosis of this disease in Brazil is late and incomplete, which results in increased morbidity and mortality in this age group. Early diagnosis of this condition is the prerogative of generalist pediatricians, and the aim of this study was to review the clinical signs and symptoms associated with developmental abnormalities of the genitourinary tract. Data sources: Based on the description of a symbolic clinical case, the authors conducted a non-systematic review of medical literature. Data synthesis: The results suggest that the following data should be used as a warning for early diagnosis of affected children: (a) combined urinary tract abnormalities (chromosomal abnormalities; sequence of malformations [VACTERLand Prune-Belly]; and musculoskeletal, digestive tract, heart, and nervous system malformations); (b) previous history (congenital anomalies of the kidney and urinary tract [CAKUT] in the family, low birth weight, and oligoamnios); (c) clinical signs (polyuria/nocturia, urinary tract infection, systemic arterial hypertension, failure to thrive, weak urinary stream, difficulty to start urination, distended bladder, non-monosymptomatic enuresis, urinary/urge incontinence, and bowel and bladder dysfunction); and (d) pre- and postnatal ultrasonographic alterations (increased anteroposterior diameter of the renal pelvis, mainly in the third trimester of pregnancy; single kidney; hydronephrosis associated with other abnormalities; and hydronephrosis with parenchymal involvement in the post-neonatal assessment). Conclusion: The suggestions shown here can help the pediatrician to establish clinical hypotheses for the early diagnosis of developmental abnormalities of the genitourinary tract without resorting to expensive and invasive procedures.

Resumo Objetivo: As anormalidades do desenvolvimento do trato geniturinário são a principal causa de doença renal crônica (DRC) em crianças. O diagnóstico dessa doença no Brasil é formulado de maneira incompleta e tardia, o que resulta em aumento na morbimortalidade nessa faixa etária. O diagnóstico precoce dessa condição é prerrogativa dos pediatras generalistas e o objetivo deste trabalho foi revisar os sinais e sintomas clínicos associados às anormalidades do desenvolvimento do trato geniturinário. Fontes dos dados: A partir da descrição de um caso clínico simbólico, fizemos uma revisão não sistemática da literatura médica. Síntese dos dados: Os resultados sugerem que os seguintes dados devem ser usados como alerta para o diagnóstico precoce das crianças acometidas: a) anomalias do trato urinário compostas (anomalias cromossômicas, sequências de malformações – Vacterl e Prune-Belly, malformações musculoesqueléticas, do trato digestivo, cardíacas e do sistema nervoso); b) antecedentes (anomalias congênitas do rim e trato urinário (CAKUT) na família, baixo peso ao nascer e oligoâmnio); c) sinais clínicos (polaciúria/noctúria, infecção urinária, hipertensão arterial sistêmica, baixo ganho de peso, jato urinário fraco, dificuldade para iniciar a micção, bexigoma, enurese não monossintomática, urge/incontinência urinária, disfunção do intestino e da bexiga) e d) alterações ultrassonográficas ante e pós-natais (diâmetro anteroposterior da pélvis renal aumentado principalmente no terceiro trimestre da gestação, rim único, hidronefrose associada a outras anomalias e hidronefrose com comprometimento de parênquima na avaliação pós-neonatal). Conclusão: As sugestões apresentadas podem ajudar o pediatra a estabelecer hipóteses clínicas para o diagnóstico precoce das anormalidades do desenvolvimento do trato geniturinário sem metodologias caras e invasivas.

Aplicação do instrumento de avaliação da qualidade de vida do estudante de medicina em escola pública de Brasília / Application of the questionnaire to evaluate the quality of life of medical student in health public school of Brasília, Brazil

Objetivo: Avaliar aspectos da qualidade de vida do estudante de medicina em escola de Brasília, correlacionando-os a possíveis fatores, subsidiando processo de gestão acadêmica. Métodos: Estudo descritivo e transversal. Foram analisados 345 estudantes do curso de Medicina de primeiro a sexto anos por meio de aplicação do instrumento de avaliação da qualidade de vida do estudante de medicina quanto aos domínios: Geral, Físico, de Gestão De Tempo, Ambiente de Ensino e Psicológico. Resultados: Método de ingresso no curso: 77,1% dos entrevistados provenientes de ampla concorrência, 19,7% oriundos de vagas por cotas sociais, 3,2% transferidos de outra instituição. Em relação aos domínios Geral, Físico, Ambiente de Ensino e Psicológico, o segundo ano apresentou a maior e o quarto ano a pior pontuação para qualidade de vida em relação a outros anos do curso (p<0,05). No domínio Gestão de Tempo, não houve diferença estatística entre os anos. Finalmente, no escore total, foi ratificado o segundo ano como o de melhor qualidade de vida na escola e o quarto ano como o de pior, seguido pelo sexto ano (p<0,05). Conclusão: A análise da qualidade de vida do estudante possibilita a abordagem e a intervenção precoce na formação educacional para minimizar a exposição e as consequências de fatores estressantes. Estes dados foram importantes para a reestruturação de uma política de desenvolvimento e apoio ao discente