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Journal of the Royal Army Medical Corps

Military nephrology: magnitude of rates of deterioration in renal function.


PMID 23720591

Abstract

To review military cases of renal disease seen between 1985 and 2011 to assess the magnitude of rates of deterioration in renal function according to diagnosis when therapeutic interventions were employed and to compare these with data from civilian patients. A 26-year archive of out-patient consultations, discharge summaries and renal biopsies was reviewed according to diagnosis. Serum creatine concentration and demographic data permitted retrospective calculation of estimated glomerular filtration rate (eGFR) at presentation and follow-up. Calculation of an annualised rate of deterioration of eGFR (ΔeGFR, ml/min/1.73 m(2)/y) was undertaken when there were at least four follow-up values. Eight of 13 (61%) conditions included cases where eGFR deteriorated significantly with time and this was present in 40/161 (25%) individual cases. Those diseases where 10% or more of cases showed significant deterioration in eGFR were hypertensive/ischaemic nephropathy (10%), immunoglobulin A nephropathy (22%), Henoch-Schönlein nephritis (28%), focal and segmental glomerulosclerosis (30%), membranous nephropathy (57%), acquired single kidney status (60%) and adult polycystic kidney disease (68%). In the latter condition, frequency of significant deterioration was greater (p<0.0001) than in civilian patients. Median ΔeGFR values ranged from -1.8 to -9.1 ml/min/1.73 m(2)/y in military patients and were similar to those of civilian patients. Cases of renal disease discovered de novo in serving military personnel showed deterioration of renal function with time in a significant proportion despite interventions to maintain renal function. The magnitude of rates of deterioration was similar to that of civilian patients suggesting that military medical management strategy was appropriate. These results support a traditional restrictive policy concerning applicants with a history of renal disease.