Primary renal disease in young adults with renal failure

Abstract

Background: No specific data have been published on primary renal disease (PRD) in young adults with end-stage renal failure (ESRF). For children, congenital abnormalities of the kidney and urinary tract (CAKUT) account for 50% of renal failure and other congenital and familial disease comprise 20%. This remains true for teenage children in paediatric registries.

Methods: To investigate the causes of ESRF in young adults, the UK Renal Registry data for the period 2000-2006 have been reviewed and PRD reported for all aged 18-39 years. For comparison, US Renal Data System (USRDS) results are available for age groups 0-19, 20-29 and 30-39 years. These data are also compared with data reported by the British Association of Paediatric Nephrology (BAPN).

Results: For the UK, there is a rise in the rate of 'aetiology uncertain' from 6% at 12-15 years to 21% by 18-21 years. This figure of 21% remains constant for the older patients in their third and fourth decades and can be increased by at least 5% by adding 'glomerulonephritis; histologically examined but unspecified'; but these figures compare with unknown rates of 36% for the US age group 20-29 years. In the UK, for those 18-21 years, 'glomerulonephritis' accounts for 28%, when 'Alport's disease' (6.5%) and 'unspecified' (4.5%) are excluded, which compares with age 12-15 of 26%. At age 18-21 years in the UK, there is a sharp decline in all CAKUT (26%) when compared with the BAPN incidence for the 12-15 age group of 45%. For those in their third decade, diabetes accounts for 14-18% of diagnoses, distorting our ability to compare data by percentage.

Conclusions: These young adult data in the UK are consistent with the hypothesis that many of the undiagnosed cases must be CAKUT or tubular disease.