Chronic Kidney Disease in Children (CKiD)

该应用程序是NAPRTCS 26个中心的共同努力，标题为“慢性肾功能不全 (CRI)NAPRTCS患者。我们将招募300名儿童（1-16岁）， GFR为25-75 mL/min/1.73m2。随访时进行年度GFR和6个月体格检查 并测定血红蛋白、电解质、血清、白蛋白、血清钙、血清磷 甲状旁腺激素和尿指标将检验第一个假设，即该队列将最准确地 定义CRI进展的发生率和风险因素，并且该进展将与 蛋白尿、白蛋白、血压、营养状况、生长和甲状旁腺功能亢进。测试 第二个假设是，轻度CRI儿童发生心血管疾病， 随着CRI的进展，发病率和严重程度增加，我们将进行基线 以及每年24小时动态血压监测、超声心动图评估， 测定左心室质量和左心室功能，以及颈动脉的B型超声， 测定颈动脉顺应性和IMT。为了验证第三个假设， CRI患儿的预后受肾功能不全进展的影响， 将在研究入组时以及6、12和24个月时进行经验证的神经认知测试，以评估 许多大脑皮层和皮层下区域的功能。为了检验第四个假设， 炎症有助于恶病质，生长激素抵抗和生长迟缓，我们将 检查循环细胞因子和神经肽浓度对饮食摄入、营养和代谢的影响。 和生长参数以及生长激素轴扰动和对生长的反应性 激素疗法最后，为了检验第五个假设，即骨组织学， 血清PTH浓度和测量的GFR，我们将测量和表征生化和 肾性骨营养不良的组织学特征，并确定 与正常的骨形成率有关。

This application, a joint effort of 26 centers of the NAPRTCS, is entitled "Chronic Renal Insufficiency (CRI) in NAPRTCS Patients. We will enroll 300 children (1-16 years) with measured glomerular filtration rates (GFR) of 25-75 mL/min/1.73m2. Follow-up with annual GFR and 6 month physical examinations and determinations of hemoglobin, electrolytes, serum, albumin, serum calcium, serum phosphorus, parathyroid hormone and urinary indices will test the 1st hypothesis that this cohort will most accurately define the rate of and the risk factors for progression of CRI, and that this progression will be correlated with proteinuria, albumin, blood pressure, nutritional status, growth and hyperparathyroidism. To test the 2nd hypothesis that cardiovascular disease develops in children with mild CRI and that its orevalence and severity increase in association with the progression of CRI, we will perform baseline and annual 24-hour ambulatory blood pressure monitoring, echocardiographic assessments to determine left-ventricularmass and LV function, and B-mode ultrasound of the carotid artery to determine the IMT and carotid artery compliance. To test the 3rd hypothesis that the neurocognitive outcome of children with CRI is influenced by the progression of renal insufficiency, a battery of validated neurocognitive tests will be conducted at study entry and at 6, 12 and 24 months to assess many cortical and subcortical areas of brain function. To test the 4th hypothesis that chronic inflammation contributes to cachexia, growth hormone resistance and growth retardation, we will examine the impact of circulating cytokine and neuropeptide concentrations on dietary intake, nutritional and growth parameters as well as growth hormone axis pertubations and responsiveness to growth hormone therapy. Finally, to test the 5th hypothesis that a correlation exist between bone histology, serum concentration of PTH and measured GFR, we will measure and characterize the biochemical and histologic features of renal osteodystrophy and determine the serum concentrations of PTH that are associated with normal rates of bone formation.