Identification of individuals at risk of chronic kidney disease (CKD) might enable early intervention. A new study by Asaf Vivante and colleagues reports that adults with a history of kidney disease that did not progress to CKD in childhood have a significantly increased risk of developing end-stage renal disease (ESRD).

“We hypothesized that even mild, seemingly resolved kidney disease in childhood could cause subclinical kidney damage that might lead to a reduction in kidney reserve and increase the risk of CKD in adulthood,” says Vivante. “To investigate this hypothesis we drew our study sample from the Israeli Defence Forces database and included 1,521,501 adolescents who underwent routine, standardized health assessments prior to mandatory military service between 1967 and 1997. We then linked this cohort with the Israeli ESRD registry, which includes data on all patients in Israel with ESRD from 1980 onwards.”

Our study highlights mild childhood kidney disease as a newly appreciated risk factor for future CKD

During 30 years of follow-up, 2,490 of the study participants developed ESRD. A history of mild or resolved childhood kidney disease with no clinical or laboratory evidence of compromised glomerular filtration rate, hypertension or proteinuria in adolescence was associated with a significantly increased risk of ESRD in adulthood (HR 4.19, 95% CI 3.52–4.99) and with a younger age at onset of ESRD (HR for ESRD in adults aged <40 years 10.40, 95% CI 7.96–13.59).

“Our study highlights mild childhood kidney disease as a newly appreciated risk factor for future CKD,” concludes Vivante. “Clinicians should be aware of the residual risk of CKD among adults — particularly young adults — with a history of kidney disease in childhood.”