Chronic Renal Insufficiency in NAPRTCS Patients

NAPRTCS 患者的慢性肾功能不全

• 批准号: 6804465
• 负责人: Bradley Alan Warady
• 金额: $ 67.09万
• 依托单位: CHILDREN'S MERCY HOSP (KANSAS CITY, MO)
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6804465
• 关键词: adolescence (12-20); albumins; blood pressure; bone development; cachexia; cardiovascular disorder; child (0-11); child physical development; children; chronic renal failure; clinical research; comorbidity; cooperative study; cytokine; echocardiography; glomerular filtration rate; hormone therapy; human morbidity; human mortality; human subject; hyperparathyroidism; immunologic assay /test; longitudinal human study; neuropeptides; neurophysiology; neuropsychological tests; nutrition; parathyroid hormones; patient oriented research; proteinuria; renal rickets; ultrasound; ventricular hypertrophy

DESCRIPTION (provided by applicant): 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 prevalence 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-ventricular mass 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.

描述（由申请人提供）： 该应用程序是 NAPRTCS 26 个中心的共同努力，题为“NAPRTCS 患者的慢性肾功能不全 (CRI)”。我们将招募 300 名儿童（1-16 岁），测量的肾小球滤过率 (GFR) 为 25-75 mL /min/1.73m2 进行年度 GFR 随访和 6 个月体检以及血红蛋白、电解质、血清、白蛋白、血清钙、血清磷、甲状旁腺激素和尿指数将检验第一个假设，即该队列将最准确地定义 CRI 进展的发生率和危险因素，并且这种进展将与蛋白尿、白蛋白、血液为了检验第二个假设，即患有轻度 CRI 的儿童会发生心血管疾病，并且其患病率和严重程度随着 CRI 的进展而增加，我们将进行基线和每年 24 小时动态检查。血压监测、超声心动图评估以确定左心室质量和左心室功能，以及颈动脉 B 型超声以确定 IMT 和颈动脉顺应性。为了检验第三个假设，即 CRI 儿童的神经认知结果受到肾功能不全进展的影响，将在研究开始时以及第 6、12 和 24 个月时进行一系列经过验证的神经认知测试，以评估许多皮质和皮质下区域大脑功能。为了检验第四个假设，即慢性炎症导致恶病质、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、营养和生长参数以及生长激素轴扰动和对生长激素的反应的影响治疗。最后，为了检验第五个假设，即骨组织学、PTH 血清浓度和测量的 GFR 之间存在相关性，我们将测量和表征肾性骨营养不良的生化和组织学特征，并确定与正常发生率相关的 PTH 血清浓度。骨形成。