Identification of young adults at risk of an accelerated loss of kidney function in an area affected by Mesoamerican nephropathy

BackgroundAfter two-years of follow-up of 263 apparently healthy 18- to 30-year-old men in communities affected by Mesoamerican nephropathy(MeN), we identified three distinct case groups: a subgroup with (i) established renal dysfunction (case-group 1); individuals with (ii) a rapid decline in kidney function (case-group 2); and individuals with (iii) stable kidney function (non-cases). This paper investigates whether local tests are potentially useful for the timely identification of these case groups.MethodsCreatinine levels were measured in local laboratories every six months for two years. Aliquots were sent to a centralized laboratory for measurements of cystatin C and creatinine levels. We investigated agreement between the locally and centrally measured creatinine-based Chronic Kidney disease Epidemiology Collaboration (CKD-EPI) equation for estimating the Glomerular Filtration Rate (eGFR). A logistic regression analysis was used to assess predictive factors for case groups 1 and 2 compared to non-cases. Predictive variables were locally measured eGFR, and urinaryneutrophil gelatinase-associated lipocalin (uNGAL) levels. The discrimination performance of the model was assessed using the area under the receiver operating characteristic curve (AUC).ResultsConsiderable variation in local eGFR measurements was observed. The prediction model for case-group 1 included baseline kidney functionand with orwithoutuNGAL (AUC=0.98, 95% confidence interval (CI), 0.91-1.00). The prediction model for case-group 2 also required eGFR(Scr) at six and twelve months after baseline, with or without uNGAL levels (AUC=0.88; 95% CI 0.80-0.99).ConclusionsEstablished renal dysfunction was detected at a single time point using local measurements and uNGAL. For the detection of a rapid decline in kidney function over time, at least 2 more measurements at six and twelve months are needed.