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Latoch E, Konończuk K, Jander A, Trembecka-Dubel E, Wasilewska A, Taranta-Janusz K. Galectin-3-A New Player of Kidney Damage or an Innocent Bystander in Children with a Single Kidney? J Clin Med 2021; 10:jcm10092012. [PMID: 34066698 PMCID: PMC8125852 DOI: 10.3390/jcm10092012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to evaluate the galectin-3 (Gal-3) level in children with a congenital solitary functioning kidney (cSFK) and determine its association with common renal function parameters. The study consisted of 68 children (49 males) with cSFK. We demonstrated that children with cSFK had a lower level of galectin-3 than that of healthy subjects (p < 0.001). No significant differences in serum cystatin C (Cys C) levels between the cSFK children and the reference group were found. The subjects with cSFK and reduced estimated glomerular filtration rate (eGFR) had significantly higher levels of Gal-3 and Cys C compared to those with normal eGFR (p < 0.05). Children with eGFR <60 mL/min/1.73 m2 showed significant statistical differences between the values of area under ROC curve (AUC) for Gal-3 (AUC 0.91) and Cys C (AUC 0.96) compared to that for creatinine level (AUC 0.76). Similar analyses carried out among cSFK children with eGFR <90 mL/min/1.73 m2 revealed an AUC value of 0.69 for Gal-3, 0.74 for Cys C, and 0.64 for creatinine; however, no significant superiority was shown for any of them. The receiver operating characteristic (ROC) analyses for identifying the SFK children among all participants based on the serum levels of Gal-3 and Cys C did not show any diagnostic profile (AUCs for Gal-3 and Cys C were 0.22 and 0.59, respectively). A positive correlation between the Gal-3 and Cys C concentrations was found (r = 0.39, p = 0.001). We demonstrated for the first time that Gal-3 might play an important role in the subtle kidney damage in children with cSFK. However, further prospective studies are required to confirm the potential applicability of Gal-3 as an early biomarker for kidney injury and possible progression to CKD.
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Affiliation(s)
- Eryk Latoch
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-274 Białystok, Poland; (E.L.); (K.K.)
| | - Katarzyna Konończuk
- Department of Pediatric Oncology and Hematology, Medical University of Bialystok, 15-274 Białystok, Poland; (E.L.); (K.K.)
| | - Anna Jander
- Department of Pediatrics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute, 93-338 Łódź, Poland;
| | - Elżbieta Trembecka-Dubel
- Department of Pediatrics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland;
| | - Anna Wasilewska
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-274 Białystok, Poland;
| | - Katarzyna Taranta-Janusz
- Department of Pediatrics and Nephrology, Medical University of Bialystok, 15-274 Białystok, Poland;
- Correspondence: ; Tel.: +48-85-745-0651
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G Kalaitzidis R. Should we need more sensitive early diagnostic markers in children with congenital solitary functioning kidneys? J Clin Hypertens (Greenwich) 2020; 23:253-256. [PMID: 33369854 PMCID: PMC8029997 DOI: 10.1111/jch.14158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
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McArdle Z, Schreuder MF, Moritz KM, Denton KM, Singh RR. Physiology and Pathophysiology of Compensatory Adaptations of a Solitary Functioning Kidney. Front Physiol 2020; 11:725. [PMID: 32670095 PMCID: PMC7332829 DOI: 10.3389/fphys.2020.00725] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022] Open
Abstract
Children born with a solitary functioning kidney (SFK) have an increased risk of hypertension and kidney disease from early in adulthood. In response to a reduction in kidney mass, the remaining kidney undergoes compensatory kidney growth. This is associated with both an increase in size of the kidney tubules and the glomeruli and an increase in single nephron glomerular filtration rate (SNGFR). The compensatory hypertrophy and increase in filtration at the level of the individual nephron results in normalization of total glomerular filtration rate (GFR). However, over time these same compensatory mechanisms may contribute to kidney injury and hypertension. Indeed, approximately 50% of children born with a SFK develop hypertension by the age of 18 and 20–40% require dialysis by the age of 30. The mechanisms that result in kidney injury are only partly understood, and early biomarkers that distinguish those at an elevated risk of kidney injury are needed. This review will outline the compensatory adaptations to a SFK, and outline how these adaptations may contribute to kidney injury and hypertension later in life. These will be based largely on the mechanisms we have identified from our studies in an ovine model of SFK, that implicate the renal nitric oxide system, the renin angiotensin system and the renal nerves to kidney disease and hypertension associated with SFK. This discussion will also evaluate current, and speculate on next generation, prognostic factors that may predict those children at a higher risk of future kidney disease and hypertension.
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Affiliation(s)
- Zoe McArdle
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, Netherlands
| | - Karen M Moritz
- Child Health Research Centre and School of Biomedical Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Kate M Denton
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia
| | - Reetu R Singh
- Cardiovascular Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, VIC, Australia
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Cochat P, Febvey O, Bacchetta J, Bérard E, Cabrera N, Dubourg L. Towards adulthood with a solitary kidney. Pediatr Nephrol 2019; 34:2311-2323. [PMID: 30276534 DOI: 10.1007/s00467-018-4085-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/03/2018] [Accepted: 09/10/2018] [Indexed: 02/07/2023]
Abstract
Around 1/1000 people have a solitary kidney. Congenital conditions mainly include multicystic dysplastic kidney and unilateral renal aplasia/agenesis; acquired conditions are secondary to nephrectomy performed because of urologic structural abnormalities, severe parenchymal infection, renal trauma, and renal or pararenal tumors. Children born with congenital solitary kidney have a better long-term glomerular filtration rate than those with solitary kidney secondary to nephrectomy later in life. Acute and chronic adaptation processes lead to hyperfiltration followed by fibrosis in the remnant kidney, with further risk of albuminuria, arterial hypertension, and impaired renal function. Protective measures rely on non-pharmacological renoprotection (controlled protein and sodium intake, avoidance/limitation of nephrotoxic agents, keeping normal body mass index, and limitation of tobacco exposure). Lifelong monitoring should include blood pressure and albuminuria assessment, completed by glomerular filtration rate (GFR) estimation in case of abnormal values. In the absence of additional risk factors to solitary kidney, such assessment can be proposed every 5 years. There is no current consensus for indication and timing of pharmacological intervention.
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Affiliation(s)
- Pierre Cochat
- Centre de référence des maladies rénales rares Néphrogones, Hospices Civils de Lyon, Lyon, France.
- EPICIME Epidémiologie Pharmacologie Investigation Clinique Information Médicale de l'Enfant, Hospices Civils de Lyon, Lyon, France.
- Université Claude-Bernard Lyon 1, Lyon, France.
- Service de Néphrologie Rhumatologie Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, 69677, Bron Cedex, France.
| | - Olivia Febvey
- EPICIME Epidémiologie Pharmacologie Investigation Clinique Information Médicale de l'Enfant, Hospices Civils de Lyon, Lyon, France
| | - Justine Bacchetta
- Centre de référence des maladies rénales rares Néphrogones, Hospices Civils de Lyon, Lyon, France
- EPICIME Epidémiologie Pharmacologie Investigation Clinique Information Médicale de l'Enfant, Hospices Civils de Lyon, Lyon, France
- Université Claude-Bernard Lyon 1, Lyon, France
| | | | - Natalia Cabrera
- Centre de référence des maladies rénales rares Néphrogones, Hospices Civils de Lyon, Lyon, France
| | - Laurence Dubourg
- Centre de référence des maladies rénales rares Néphrogones, Hospices Civils de Lyon, Lyon, France
- Université Claude-Bernard Lyon 1, Lyon, France
- Exploration fonctionnelle rénale, Hospices Civils de Lyon, Lyon, France
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Abstract
Life with a solitary functioning kidney (SFK) may be different from that when born with two kidneys. Based on the hyperfiltration hypothesis, a SFK may lead to glomerular damage with hypertension, albuminuria and progression towards end-stage renal disease. As the prognosis of kidney donors was considered to be very good, having a SFK has been considered to be a benign condition. In contrast, our research group has demonstrated that being born with or acquiring a SFK in childhood results in renal injury before adulthood in over 50% of those affected. Most congenital cases will be detected during antenatal ultrasound screening, but up to 38% of cases of unilateral renal agenesis are missed. In about 25-50% of cases of antenatally detected SFK there will be signs of hypertrophy, which could indicate additional nephron formation and is associated with a somewhat reduced risk of renal injury. Additional renal and extrarenal anomalies are frequently detected and may denote a genetic cause for the SFK, even though for the majority of cases no explanation can (yet) be found. The ongoing glomerular hyperfiltration results in renal injury, for which early markers are lacking. Individuals with SFK should avoid obesity and excessive salt intake to limit additional hyperfiltration. As conditions like hypertension, albuminuria and a mildly reduced glomerular filtration rate generally do not result in specific complaints but may pose a threat to long-term health, screening for renal injury in any individual with a SFK would appear to be imperative, starting from infancy. With early treatment, secondary consequences may be diminished, thereby providing the optimal life for anyone born with a SFK.
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Dönmez O, Korkmaz HA, Yıldız N, Ediz B. Comparison of serum cystatin C and creatinine levels in determining glomerular filtration rate in children with stage I to III chronic renal disease. Ren Fail 2015; 37:784-90. [DOI: 10.3109/0886022x.2015.1014771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kolvek G, Podracka L, Rosenberger J, Stewart RE, van Dijk JP, Reijneveld SA. Solitary Functioning Kidney in Children - A Follow-Up Study. Kidney Blood Press Res 2014; 39:272-8. [DOI: 10.1159/000355804] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 11/19/2022] Open
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Flögelová H, Langer J, Šmakal O, Michálková K, Bakaj-Zbrožková L, Zapletalová J. Renal parenchymal thickness in children with solitary functioning kidney. Pediatr Nephrol 2014; 29:241-8. [PMID: 24013498 DOI: 10.1007/s00467-013-2610-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 08/01/2013] [Accepted: 08/06/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Reduced renal parenchymal thickness (PT) is a parameter used by clinicians to assess the degree of hydronephrosis. In patients with a congenital hydronephrotic solitary functioning kidney (SFK), PT is difficult to determine as there is no comparison with the contralateral kidney. The aim of this study was to obtain ultrasound measurements of PT in children with normal SFK and to compare these data with PT measurements in children with two functioning kidneys. METHODS This was a prospective multicenter study carried out between 2006 and 2011 in which 236 children aged 11 days to 18.96 years with healthy SFK were examined. The SFK etiologies were unilateral renal agenesis or a nonfunctioning contralateral kidney, mostly due to multicystic dysplasia. In addition to determining other parameters, we measured PT in the middle third of the kidney by ultrasound. Correlations between PT and age, height and weight were assessed. RESULTS Correlation analysis showed a positive correlation with renal PT for all parameters. The correlation coefficients for age, height and weight were 0.863, 0.873 and 0.874, respectively. In most age categories, the renal parenchyma was significantly thicker in the SFK than in two functioning kidneys. CONCLUSIONS Based on our results, we suggest that PT in the SFK is correlated with height, weight and age of the patient. Consequently, measurements of PT may be used for monitoring the development of the healthy SFK and may contribute to a more accurate assessment of the severity of SFK anomalies.
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Affiliation(s)
- Hana Flögelová
- Department of Pediatrics, University Hospital Olomouc, I. P. Pavlova 6, 775 20, Olomouc, Czech Republic,
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Growth and function in childhood of a normal solitary kidney from birth or from early infancy. Pediatr Nephrol 2014; 29:249-56. [PMID: 24043649 DOI: 10.1007/s00467-013-2623-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 08/23/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Children with a solitary kidney (SK) have an increased long-term risk of hypertension, albuminuria and glomerulosclerosis. In this study, we assessed the early signs of impaired glomerular filtration in children with a SK from birth or from early infancy. METHODS Renal growth and function at ages 4-15.5 years were studied in 38 children with SK and 40 matched control subjects in terms of accelerated growth. RESULTS The systolic/diastolic blood pressure Z-scores (p = 0.01/<0.05) and the resistance index (RI) of the arcuate arteries (p = 0.05) were higher in the children with SK. Creatinine clearance and 24-h protein and albumin urinary excretion showed no difference. All but seven children with SK had 99mTc diethylene-triamine pentaacetic acid glomerular filtration rate values of >80 ml/min/1.73 m(2). An independent positive correlation was found between length of the follow-up time and 24-h albumin urinary excretion (β = 0.54, p < 0.01). Accelerated postnatal growth was positively related with kidney volume (β = 0.35, p < 0.05). CONCLUSIONS Among our patient cohort, renal function was well preserved at ages 4-15.5 years in children who were born with a SK. However, both their higher blood pressure and RI and the correlation of 24-h albumin urinary excretion with length of follow-up time underline the need for monitoring to detect early signs of glomerular hyperfiltration and, if necessary, implement timely intervention. SK hypertrophy was found to be correlated with postnatal growth.
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Westland R, Schreuder MF, van Goudoever JB, Sanna-Cherchi S, van Wijk JAE. Clinical implications of the solitary functioning kidney. Clin J Am Soc Nephrol 2013; 9:978-86. [PMID: 24370773 DOI: 10.2215/cjn.08900813] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Congenital anomalies of the kidney and urinary tract are the major cause of ESRD in childhood. Children with a solitary functioning kidney form an important subgroup of congenital anomalies of the kidney and urinary tract patients, and a significant fraction of these children is at risk for progression to CKD. However, challenges remain in distinguishing patients with a high risk for disease progression from those patients without a high risk of disease progression. Although it is hypothesized that glomerular hyperfiltration in the lowered number of nephrons underlies the impaired renal prognosis in the solitary functioning kidney, the high proportion of ipsilateral congenital anomalies of the kidney and urinary tract in these patients may further influence clinical outcome. Pathogenic genetic and environmental factors in renal development have increasingly been identified and may play a crucial role in establishing a correct diagnosis and prognosis for these patients. With fetal ultrasound now enabling prenatal identification of individuals with a solitary functioning kidney, an early evaluation of risk factors for renal injury would allow for differentiation between patients with and without an increased risk for CKD. This review describes the underlying causes and consequences of the solitary functioning kidney from childhood together with its clinical implications. Finally, guidelines for follow-up of solitary functioning kidney patients are recommended.
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Affiliation(s)
- Rik Westland
- Departments of Pediatric Nephrology and, §Pediatrics, VU University Medical Center, Amsterdam, The Netherlands;, †Division of Nephrology, Columbia University, New York, New York;, ‡Department of Pediatric Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, ‖Department of Pediatrics, Emma Children's Hospital, Amsterdam Medical Center, Amsterdam, The Netherlands
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Westland R, Kurvers RAJ, van Wijk JAE, Schreuder MF. Risk factors for renal injury in children with a solitary functioning kidney. Pediatrics 2013; 131:e478-85. [PMID: 23319536 DOI: 10.1542/peds.2012-2088] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The hyperfiltration hypothesis implies that children with a solitary functioning kidney are at risk to develop hypertension, proteinuria, and chronic kidney disease. We sought to determine the presenting age of renal injury and identify risk factors for children with a solitary functioning kidney. METHODS We evaluated 407 patients for signs of renal injury, defined as hypertension, proteinuria, an impaired glomerular filtration rate, and/or the use of renoprotective medication. Patients were subdivided on the basis of type of solitary functioning kidney and the presence of ipsilateral congenital anomalies of the kidney and urinary tract (CAKUT). The development of renal injury was analyzed with Kaplan-Meier analysis. Risk factors were identified by using logistic regression models. RESULTS Renal injury was found in 37% of all children. Development of renal injury increased by presence of ipsilateral CAKUT (odds ratio [OR] 1.66; P = .04) and age (OR 1.09; P < .001). Renal length was inversely associated with the risk to develop renal injury (OR 0.91; P = .04). In all patients, the median time to renal injury was 14.8 years (95% confidence interval 13.7-16.0 years). This was significantly shortened for patients with ipsilateral CAKUT (12.8 years, 95% confidence interval 10.6-15.1 years). CONCLUSIONS Our study determines independent risk factors for renal injury in children with a solitary functioning kidney. Because many children develop renal injury, we emphasize the need for clinical follow-up in these patients starting at birth.
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Affiliation(s)
- Rik Westland
- Department of Pediatric Nephrology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, Netherlands.
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Westland R, Abraham Y, Bökenkamp A, Stoffel-Wagner B, Schreuder MF, van Wijk JAE. Precision of estimating equations for GFR in children with a solitary functioning kidney: the KIMONO study. Clin J Am Soc Nephrol 2013; 8:764-72. [PMID: 23371960 DOI: 10.2215/cjn.07870812] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Children with a solitary functioning kidney may develop CKD. Although widely used, equations to estimate GFR are not validated in these patients. This study sought to determine the precision of common estimating equations in the KIMONO (KIdney of MONofunctional Origin) cohort. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Two creatinine-based (estimated GFR [eGFR]-Schwartz, urinary creatinine clearance), two cystatin C-based (eGFR-Zappitelli1, eGFR-CKiD [Chronic Kidney Disease in Children] 1), and two cystatin C/creatinine-based (eGFR-Zappitelli2, eGFR-CKiD2) estimates were compared with the gold standard GFR measured by inulin single injection (GFR-inulin) in 77 children with a solitary functioning kidney (time span of assembly, 2005-2012). Included patients were 1.5-19.8 years of age. Kidney Disease Outcomes Quality Initiative (K/DOQI) classification was compared between GFR-inulin and eGFR methods to analyze misclassification by estimating equations. RESULTS The eGFR-CKiD2 equation performed best in children with a solitary functioning kidney (mean bias, -0.9 ml/min per 1.73 m(2); 95% and 54% of values within ±30% and ±10% of GFR-inulin, respectively). Mean bias for eGFR-Schwartz was 0.4 ml/min per 1.73 m(2), with 90% and 33% of values within ±30% and ±10% of GFR-inulin, respectively. For all estimates, misclassification in K/DOQI stage ranged from 22% (eGFR-Zappitelli1) to 44% (urinary creatinine clearance) of children. CONCLUSIONS Use of a combined serum cystatin C/creatinine-based equation (eGFR-CKiD2) is recommended to monitor renal function in children with a solitary functioning kidney. When cystatin C is not routinely available, eGFR-Schwartz should be used. Misclassification in K/DOQI-stage remains a caveat for all equations.
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Affiliation(s)
- Rik Westland
- Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
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Peco-Antić A, Paripović D, Kotur-Stevuljević J, Stefanović A, Sćekić G, Miloševski-Lomić G. Renal functional reserve in children with apparently normal congenital solitary functioning kidney. Clin Biochem 2012; 45:1173-7. [PMID: 22732526 DOI: 10.1016/j.clinbiochem.2012.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 06/07/2012] [Accepted: 06/14/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the study was to investigate renal functional reserve (RFR) and to assess its relationship with serum cystatin C and blood pressure in children with apparently normal congenital solitary functioning kidney (SFK). MATERIAL AND METHODS RFR was obtained from the difference of endogenous creatinine clearance (CrCs) before and after a meat-free oral protein load (OPL) in the patients who were pre-treated with cimetidine. Serum cystatin C and urinary protein excretion were determined before and after OPL. RESULTS Among 22 patients (13 boys), aged 9.5 ± 4.3 years, 72.7% had increased serum cystatin C, and 54.5% had decreased RFR. Following OPL, CrCs and urine creatinine increased, while serum creatinine and cystatin C remained unchanged. The multiple regression analysis demonstrated that cystatin C could predict more than 90% of RFR variability. CONCLUSION Half of the patients with apparently normal SFK had decreased RFR. Serum cystatin C is one of the best predictors of RFR.
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Corbani V, Ghiggeri GM, Sanna-Cherchi S. 'Congenital solitary functioning kidneys: which ones warrant follow-up into adult life?'. Nephrol Dial Transplant 2011; 26:1458-60. [PMID: 21467130 DOI: 10.1093/ndt/gfr145] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Westland R, Schreuder MF, Bökenkamp A, Spreeuwenberg MD, van Wijk JAE. Renal injury in children with a solitary functioning kidney--the KIMONO study. Nephrol Dial Transplant 2011; 26:1533-41. [PMID: 21427076 DOI: 10.1093/ndt/gfq844] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Children with a solitary functioning kidney (SFK) have an increased risk of developing hypertension, albuminuria and chronic kidney disease in later life. This renal injury is hypothesized to be caused by glomerular hyperfiltration that follows renal mass reduction in animal studies. Furthermore, children with an SFK show a high incidence of congenital anomalies of the kidney and urinary tract (CAKUT), which could further compromise renal function. METHODS A retrospective study of renal injury markers was performed in 206 children, divided into groups based on the origin of SFK [primary (congenital) SFK (n = 116) and secondary SFK (n = 90)]. Data on ipsilateral CAKUT were stratified separately. For blood pressure, albuminuria and glomerular filtration rate, longitudinal models were additionally developed using generalized estimated equation analysis. RESULTS Renal injury, defined as the presence of hypertension and/or albuminuria and/or the use of renoprotective medication, was present in 32% of all children with an SFK at a mean age of 9.5 (SD 5.6) years. Children with ipsilateral CAKUT had higher proportions of renal injury (48.3 versus 24.6%, P < 0.05). Furthermore, longitudinal models showed a decrease in glomerular filtration rate in both groups from the beginning of puberty onwards. CONCLUSIONS This large cohort study demonstrates that renal injury is present in children with an SFK at a young age, whereas our longitudinal models show an increased risk for chronic kidney disease in adulthood. Renal injury is even more pronounced in the presence of ipsilateral CAKUT. Therefore, we underline that clinical follow-up of all children with an SFK is needed.
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Affiliation(s)
- Rik Westland
- Department of Paediatric Nephrology, VU University Medical Centre, Amsterdam, The Netherlands.
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Wang Y, Wang Z, Wang W, Ren H, Zhang W, Chen N. Analysis of factors associated with renal function in Chinese adults with congenital solitary kidney. Intern Med 2010; 49:2203-9. [PMID: 20962438 DOI: 10.2169/internalmedicine.49.3742] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with congenital solitary kidney have an increased risk of developing hypertension, proteinuria and renal insufficiency. However, the specific factors associated with the progression of renal function in adults with congenital solitary kidney remain still unclear. The purpose of this study was to identify factors that are independently associated with renal function progression in patients with congenital solitary kidney. METHODS Sixty-five Chinese adults with congenital solitary kidney (48 patients with unilateral renal agenesis and 17 with severe unilateral renal dysplasia) were recruited into our study retrospectively. Clinical data were analyzed. RESULTS Of sixty-five patients with congenital solitary kidney, the prevalence of hypertension, proteinuria and renal insufficiency was 36.9%, 35.4% and 38.5%, respectively. There was no significant difference in the glomerular filtration rate (GFR) between patients with and without hypertension, whereas GFR in patients with proteinuria was significantly lower than in those without proteinuria (p<0.05). While there was no statistically significant difference in prevalence of hypertension between patients with and without renal insufficiency, the prevalence of proteinuria in patients with renal insufficiency was significantly higher than in those without renal insufficiency (p<0.05). Logistic regression analysis revealed that kidney length and proteinuria were independently associated with the progression of renal function (OR=0.20, 95%CI 0.05-0.79, and OR=8.30, 95%CI 2.30-29.96, respectively). CONCLUSION Hypertension, proteinuria or renal insufficiency was present in approximately one-third of adults with congenital solitary kidney. Those with a kidney length of less than 120 mm or proteinuria had a much higher risk of renal insufficiency.
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Affiliation(s)
- Yingyu Wang
- Department of Nephrology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, PR China
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Zaffanello M, Brugnara M, Zuffante M, Franchini M, Fanos V. Are children with congenital solitary kidney at risk for lifelong complications? A lack of prediction demands caution. Int Urol Nephrol 2008; 41:127-35. [DOI: 10.1007/s11255-008-9437-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 07/01/2008] [Indexed: 10/21/2022]
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Morgan C, Senthilselvan A, Bamforth F, Hoskinson M, Gowrishankar M. Correlation between cystatin C- and renal scan-determined glomerular filtration rate in children with spina bifida. Pediatr Nephrol 2008; 23:329-32. [PMID: 17922294 DOI: 10.1007/s00467-007-0613-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 08/09/2007] [Accepted: 08/10/2007] [Indexed: 10/22/2022]
Abstract
We report on the relationships between serum cystatin C level, glomerular filtration rate (GFR) estimated from a cystatin C-based prediction equation (that of Filler and Lepage), GFR calculated by the Schwartz formula and technetium 99m-diethylene triamine penta-acetic acid ((99)Tc-DTPA)-determined GFR in 28 children with spina bifida. All children underwent measurement of height, weight, serum cystatin C level, and serum creatinine level at the time of their renal scan. The relationship between variables was assessed by Pearson correlation. Pearson correlation for the relationship between (99)Tc-DTPA GFR and GFR calculated by the cystatin C-based equation was significant and higher than that of the relationship between (99)Tc-DTPA GFR and GFR calculated by the Schwartz equation, which was not statistically significant. The correlation for Filler GFR was 0.42 (P = 0.03) and for Schwartz GFR was 0.21 (P = 0.28). Although we use renal scan determination of GFR as the best measure, and a creatinine-based formula as the most practical measure, perhaps a formula such as that published by Filler and Lepage, which is not dependent on anthropometric data, might be a more useful (and accurate) tool for establishing GFR in children with spina bifida.
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Affiliation(s)
- Catherine Morgan
- Pediatric Nephrology, Department of Pediatrics, University of Alberta, 2B2-42 Walter Mac Kenzie Health Science Centre, Edmonton, T6G 2R7, AB, Canada
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Gretz N, Schock D, Sadick M, Pill J. Bias and precision of estimated glomerular filtration rate in children. Pediatr Nephrol 2007; 22:167-9. [PMID: 17123113 DOI: 10.1007/s00467-006-0379-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2006] [Revised: 10/25/2006] [Accepted: 10/26/2006] [Indexed: 10/25/2022]
Abstract
Determining true glomerular filtration rate (GFR) using an exogenous marker is time-consuming and cumbersome. Therefore, creatinine-based estimates of GFR are used. Recent papers using new population-specific/local parameters in their prediction equations, standardizing creatinine determination or adding other endogenous surrogate markers of GFR, like cystatin C, could demonstrate an improvement of bias inherent in the results of the prediction equations. Precision, however, is still poor. Currently, we have to accept a precision (as defined in the so-called Bland-Altman plot) of +/-20% in adults and +/-30-40% in children. This problem of poor precision/uncertainty is especially bothering in the higher, near normal GFR range. Caution should be exercised when applying prediction equations in individuals in need of an accurate GFR determination. In that case, a real clearance procedure has to be performed. In the long run, the true clearance procedure should be simplified using new exogenous GFR markers and developing new devices, allowing GFR measurements to be performed, for example, transcutaneously. Such a procedure would be more acceptable for both patients and physicians.
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Woolf AS, Hillman KA. Unilateral renal agenesis and the congenital solitary functioning kidney: developmental, genetic and clinical perspectives. BJU Int 2007; 99:17-21. [PMID: 16956352 DOI: 10.1111/j.1464-410x.2006.06504.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Adrian S Woolf
- Nephro-Urology Unit, UCL Institute of Child Health, and Centre for Nephrology, Royal Free and University College Medical School, London, UK.
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