Relative risk of moderate-to-severe CKD in obese children with acute pyelonephritis

Abstract

Background:The prevalence of childhood obesity is on the rise globally, spanning both developed and developing nations, as indicated by the Centers for Disease Control and Prevention (CDC).Among children and adolescents aged 2-19 years, the median prevalence of obesity stands at 20%. Obesity represents a significant risk factor for numerous metabolic disorders, including hypertension, hypercholesterolemia, type 2 diabetes mellitus, asthma, and sleep apnea. Additionally, its association with a fourfold increase in the risk of urinary tract infections (UTIs) underscores its multifaceted health implications. The impact of obesity on renal function in children compared to their healthy counterparts remains unclear. Aim: To assess and compare the spectrum of congenital defects between healthy-weight and obese children, examine renal function, and determine the relative risk associated with specific grades of chronic kidney disease (CKD). Material & Methods:This study enrolled a total of 40 patients in a cohort, categorized into two groups: I - healthy weight (n=30) and II - obese/overweight (n=10). The study encompassed laboratory analyses, clinical examinations, and the administration of a comprehensive questionnaire following the acquisition of informed consent from all participants. Results: 1. In the healthy group, there were 5 males (16.7%) and 25 females (83.3%), whereas in the obese/overweight group, there were 3 males (30%) and 7 females (70%) [OR=0.4667; CI 95% - 0.089 to 2.451; p=0.3878]. 2. Among the participants, three individuals in group II exhibited moderate-to-severe chronic kidney disease (CKD) grades 3-5, while only one patient in group I had grade 3A CKD. Consequently, the risk of moderate-to-severe CKD was 12.4 times higher for obese children with acute pyelonephritis than for children with a healthy weight [OR=12.4; 95% CI 1.12 - 138.24; p=0.0403]. 3. In the healthy weight group, out of 30 patients, 16 (53%) were found to have some congenital anomaly. Conversely, in the obese/overweight group, out of 10 patients, 8 (80%) were diagnosed with congenital anomalies, indicating a 3.5 times higher occurrence for obese children compared to those with a healthy weight [OR=3.5; 95% CI 1.2-7.8; p=0.2633]. Conclusion: Obesity appears to be strongly associated with an increased risk of developing CKD, while also showing a trend towards a higher prevalence of congenital anomalies. However, there is no significant difference in gender distribution between the two groups. These findings underscore the importance of weight management in paediatric populations for reducing the risk of chronic health conditions.