Children who are diagnosed with glomerular disease may be at increased risk of developing hypertension as adults, according to results from a cohort study of more than 38,000 male Israeli military recruits.
The study, which appears as a Research Letter in the March 19 issue of JAMA, is authored by Asaf Vivante, MD, from the IDF Medical Corps, Tel-Hashomer, Israel, and colleagues.
Most children who develop glomerular disease have a favorable prognosis, with full resolution of signs and symptoms, the researchers note. However, they add, the long-term sequelae of that diagnosis are not fully understood.
Looking to fill that gap, the researchers conducted a cohort study of 38,144 male soldiers who had been assessed as new recruits by medical personnel between 1970 and 1997. They were periodically reassessed until they retired from service or were diagnosed with hypertension (systolic blood pressure, >140 mm Hg; or diastolic blood pressure, >90 mm Hg) or until December 31, 2010, whichever came first.
The researchers excluded men who had baseline diagnoses of unresolved glomerular disease, hypertension, diabetes, active rheumatic diseases, or any other kidney or urinary tract problems.
The investigators found a significant association between resolved glomerular disease during childhood and development of hypertension during adulthood.
"During a mean follow-up of 18 years (mean [SD] age, 35.8 [7.05] years), 2856 participants developed hypertension; 13.6% (n = 36) of participants with a medical history of resolved childhood glomerular disease and 7.4% (n = 2820) of those without such history, yielding a crude hazard ratio (HR) of 1.63 (95% CI, 1.17-2.26) and [a hazard ratio] adjusted for age and body mass index of 1.67 (95% CI, 1.20 - 2.31)," they write.
Although Dr. Vivante and colleagues concede the study has limitations, including a lack of specifics on exactly what sort of glomerular histopathologic injuries the men sustained as children, along with the relatively young age of the men at the end of follow-up. Nonetheless, they see the findings as important.
"Our results suggest that glomerular disease during childhood may represent a continuum of kidney injury that begins well before sufficient loss of excretory kidney function can be measured with standard laboratory tests, such that the first manifestation may be adult hypertension," they conclude.
Access to anonymized databases was provided by the Israeli Defense Forces Medical Corps. One of the coauthors has reported serving as a consultant to Elsevier, another has reported receiving travel reimbursement from the European Cooperation in Science and Technology. The other authors have disclosed no relevant financial relationships.
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