Men who had glomerular disease as children appear to be at heightened risk for hypertension in adulthood, according to the findings of a large, long-term study conducted among male military personnel in Israel.
At baseline evaluation, conducted prior to military recruitment at age 17 years, 264 of 38,144 healthy career personnel had a medical history of resolved childhood glomerular disease. Glomerular disease included childhood acute glomerulonephritis or nephritic syndrome. All conditions were clinically resolved by age 17 years, and all men were free of signs and symptoms for at least 2 years.
During a mean follow-up of 18 years, hypertension developed in 2,856 of the men (mean age 35.8 years). This group included 36 (13.6%) of the 264 men with resolved childhood glomerular disease and 7.4% of the 37,880 men without such a history. After adjusting for age and body mass index, childhood glomerular disease was associated with a significant 67% increased risk of hypertension.
Estimated glomerular filtration rate was below 70 mL/min/1.73 m2 for 13% of those resolved childhood glomerular disease and 10.4% of those without.
Investigators Asaf Vivante, MD, of IDF Medical Corps, Tel-Hashomer, Israel, and colleagues noted in their research letter (JAMA 2014;311:1155-1157) that acute glomerulonephritis and steroid-sensitive nephrotic syndrome are the two most common resolved childhood glomerular diseases, and earlier large studies had shown excellent long-term prognoses for such patients.
However, the researchers wrote, the long-term sequelae of resolved childhood glomerular disease are not completely understood, and these new findings suggest that having glomerular disease in 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, and adult hypertension may be the first manifestation.