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Seeman T, Šuláková T, Stabouli S. Masked Hypertension in Healthy Children and Adolescents: Who Should Be Screened? Curr Hypertens Rep 2023; 25:231-242. [PMID: 37639176 PMCID: PMC10491704 DOI: 10.1007/s11906-023-01260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE OF REVIEW The goal is to review masked hypertension (MH) as a relatively new phenomenon when patients have normal office BP but elevated out-of-office BP. Firstly, it was described in children in 2004. It has received increased attention in the past decade. RECENT FINDINGS The prevalence of MH in different pediatric populations differs widely between 0 and 60% based on the population studied, definition of MH, or method of out-of-office BP measurement. The highest prevalence of MH has been demonstrated in children with chronic kidney disease (CKD), obesity, diabetes, and after heart transplantation. In healthy children but with risk factors for hypertension such as prematurity, overweight/obesity, diabetes, chronic kidney disease, or positive family history of hypertension, the prevalence of MH is 9%. In healthy children without risk factors for hypertension, the prevalence of MH is very low ranging 0-3%. In healthy children, only patients with the following clinical conditions should be screened for MH: high-normal/elevated office BP, positive family history of hypertension, and those referred for suspected hypertension who have normal office BP in the secondary/tertiary center.
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Affiliation(s)
- Tomáš Seeman
- Department of Pediatrics, Charles University Prague, 2nd Medical Faculty, V Úvalu 84, 15006, Prague, Czech Republic.
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic.
| | - Terezie Šuláková
- Department of Pediatrics, University Hospital Ostrava, Ostrava, Czech Republic
- Department of Pediatrics, Medical Faculty, University of Ostrava, Ostrava, Czech Republic
| | - Stella Stabouli
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
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2
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La Scola C, Ammenti A, Bertulli C, Bodria M, Brugnara M, Camilla R, Capone V, Casadio L, Chimenz R, Conte ML, Conversano E, Corrado C, Guarino S, Luongo I, Marsciani M, Marzuillo P, Meneghesso D, Pennesi M, Pugliese F, Pusceddu S, Ravaioli E, Taroni F, Vergine G, Peruzzi L, Montini G. Management of the congenital solitary kidney: consensus recommendations of the Italian Society of Pediatric Nephrology. Pediatr Nephrol 2022; 37:2185-2207. [PMID: 35713730 PMCID: PMC9307550 DOI: 10.1007/s00467-022-05528-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022]
Abstract
In recent years, several studies have been published on the prognosis of children with congenital solitary kidney (CSK), with controversial results, and a worldwide consensus on management and follow-up is lacking. In this consensus statement, the Italian Society of Pediatric Nephrology summarizes the current knowledge on CSK and presents recommendations for its management, including diagnostic approach, nutritional and lifestyle habits, and follow-up. We recommend that any antenatal suspicion/diagnosis of CSK be confirmed by neonatal ultrasound (US), avoiding the routine use of further imaging if no other anomalies of kidney/urinary tract are detected. A CSK without additional abnormalities is expected to undergo compensatory enlargement, which should be assessed by US. We recommend that urinalysis, but not blood tests or genetic analysis, be routinely performed at diagnosis in infants and children showing compensatory enlargement of the CSK. Extrarenal malformations should be searched for, particularly genital tract malformations in females. An excessive protein and salt intake should be avoided, while sport participation should not be restricted. We recommend a lifelong follow-up, which should be tailored on risk stratification, as follows: low risk: CSK with compensatory enlargement, medium risk: CSK without compensatory enlargement and/or additional CAKUT, and high risk: decreased GFR and/or proteinuria, and/or hypertension. We recommend that in children at low-risk periodic US, urinalysis and BP measurement be performed; in those at medium risk, we recommend that serum creatinine also be measured; in high-risk children, the schedule has to be tailored according to kidney function and clinical data.
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Affiliation(s)
- Claudio La Scola
- Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 11, 40138, Bologna, Italy.
| | - Anita Ammenti
- Pediatric Multi-Specialistic Unit, Poliambulatorio Medi-Saluser, Parma, Italy
| | - Cristina Bertulli
- grid.6292.f0000 0004 1757 1758Pediatric Nephrology and Dialysis, Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Massarenti 11, 40138 Bologna, Italy
| | - Monica Bodria
- grid.419504.d0000 0004 1760 0109Division of Nephrology, Dialysis, Transplantation, and Laboratory On Pathophysiology of Uremia, Istituto G. Gaslini, Genova, Italy
| | | | - Roberta Camilla
- grid.432329.d0000 0004 1789 4477Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Torino, Italy
| | - Valentina Capone
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy
| | - Luca Casadio
- Unità Operativa Complessa Di Pediatria E Neonatologia, Ospedale Di Ravenna, AUSL Romagna, Ravenna, Italy
| | - Roberto Chimenz
- Unità Operativa Di Nefrologia Pediatrica Con Dialisi, Azienda Ospedaliero-Universitaria G. Martino, Messina, Italy
| | - Maria L. Conte
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Ester Conversano
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Ciro Corrado
- Pediatric Nephrology, “G. Di Cristina” Hospital, Palermo, Italy
| | - Stefano Guarino
- grid.9841.40000 0001 2200 8888Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania “Luigi Vanvitelli, Napoli, Italy
| | - Ilaria Luongo
- Unità Operativa Complessa Di Nefrologia E Dialisi, AORN Santobono – Pausilipon, Napoli, Italy
| | - Martino Marsciani
- grid.414682.d0000 0004 1758 8744Unità Operativa Di Pediatria E Terapia Intensiva Neonatale-Pediatrica, Ospedale M Bufalini, Cesena, Italy
| | - Pierluigi Marzuillo
- grid.9841.40000 0001 2200 8888Department of Woman, Child and of General and Specialized Surgery, Università Degli Studi Della Campania “Luigi Vanvitelli, Napoli, Italy
| | - Davide Meneghesso
- grid.5608.b0000 0004 1757 3470Unità Operativa Complessa Di Nefrologia Pediatrica - Dialisi E Trapianto, Dipartimento Di Salute Della Donna E del Bambino, Azienda Ospedaliero-Universitaria Di Padova, Padova, Italy
| | - Marco Pennesi
- grid.418712.90000 0004 1760 7415Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy
| | - Fabrizio Pugliese
- grid.7010.60000 0001 1017 3210Pediatric Nephrology Unit, Department of Pediatrics, Marche Polytechnic University, Ancona, Italy
| | | | - Elisa Ravaioli
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Francesca Taroni
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy
| | - Gianluca Vergine
- grid.414614.2Department of Pediatrics, Infermi Hospital, Rimini, Italy
| | - Licia Peruzzi
- grid.432329.d0000 0004 1789 4477Pediatric Nephrology Unit, Regina Margherita Department, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza, Torino, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit. Fondazione Ca’ Granda IRCCS, Policlinico Di Milano, Milano, Italy ,grid.4708.b0000 0004 1757 2822Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milan, Milano, Italy
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3
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Groen In't Woud S, van der Zanden LFM, Schreuder MF. Risk stratification for children with a solitary functioning kidney. Pediatr Nephrol 2021; 36:3499-3503. [PMID: 34137930 DOI: 10.1007/s00467-021-05168-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sander Groen In't Woud
- Department of Pediatric Nephrology, 804, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.,Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Loes F M van der Zanden
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, 804, Radboud University Medical Center, Radboud Institute for Molecular Life Sciences, Amalia Children's Hospital, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
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Akbar M, Ramayani OR, Yanni GN. Blood Pressure Differences in Nephrotic Syndrome Patients with Steroid Resistant Nephrotic Syndrome Patients and Steroid Sensitive Nephrotic Syndrome. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Syndrome nephrotic is the most common kidney disease found in pediatric kidney disease, classification based on clinical response to steroids or histopathological characteristics. Increased blood pressure in steroid-resistant nephrotic syndrome (NS) is still a complication to be aware of in cases of NS.
AIM: The aim of the study was to determine the differences in systolic and diastolic blood pressure in patients with steroid-sensitive NS and steroid-resistant NS.
METHODS: Analytical correctional study in 50 children with NS divided into 25 Steroid Resistant NS (SRNS) groups and 25 steroid sensitive NS (SSNS) people who met inclusion and exclusion criteria to assess systolic and diastolic blood pressure in each group in pediatric nephrology division of the general hospital of Haji Adam Malik Medan.
RESULTS: There is a difference in systolic blood pressure in the SRNS and SSNS groups which mean p = 0.024 and there is no difference in diastolic blood pressure in the SRNS group with SSNS p = 0.358. If linked levels of proteinuria to blood pressure, systolic and diastolic in both groups found no significant link p>0.05 high blood pressure with the degree of proteinuria in both group.
CONCLUSION: There are differences in systolic blood pressure in the SRNS and SSNS groups.
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Alfandary H, Haskin O, Goldberg O, Dagan A, Borovitz Y, Levi S, Davidovits M, Erlich T, Landau D, Pleniceanu O. Is the prognosis of congenital single functioning kidney benign? A population-based study. Pediatr Nephrol 2021; 36:2837-2845. [PMID: 33619660 DOI: 10.1007/s00467-021-04980-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/18/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the risk of kidney injury among adolescents with and without a congenital single functioning kidney (SFK). METHODS This retrospective study is based on a medical evaluation database of 17-year-old Israeli conscripts, born during 1989-1999. Those with congenital SFK diagnosis, verified by a pediatric nephrologist's review of the original military medical committee classifications, were compared to the rest of the cohort. Kidney injury (KI) was defined as proteinuria, high blood pressure (BP), or estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m2 prior to army recruitment. Risk factors for KI were examined using logistic regression. RESULTS Of 979,630 screened candidates, 353 were diagnosed with SFK. The yearly incidence of SFK gradually increased in the first years of the study, reaching a plateau in 1995 (5.5 ± 1.2/10,000 births/year). The male to female ratio was 2.7:1. Concomitant genital malformations were documented in 5.5% of those with SFK. KI was more prevalent in the SFK than the control group (42.2% vs. 23.5%, p < 0.001). All three components of KI were more common in the SFK than the control group: high BP (31.7% vs. 23.1%, p < 0.001), proteinuria (18.2% vs. 0.4%, p < 0.001), and eGFR <90 ml/min/1.73m2 (12.0% vs 0.1%, p < 0.001). Multivariate analysis of the SFK group revealed associations of higher mean BMI, male sex, and smaller ultrasonographic kidney length with KI. CONCLUSIONS This large population-based study documents a significant risk for KI among adolescents with SFK. Obesity represents a major modifiable risk factor for KI, implicating the need for closer follow-up in this group during childhood.
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Affiliation(s)
- Hadas Alfandary
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orly Haskin
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Goldberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pulmonary Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Amit Dagan
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Borovitz
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Levi
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Erlich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- Urology Department, Sheba Medical Center, Ramat Gan, Israel
| | - Daniel Landau
- Institute of Nephrology, Schneider Children's Medical Center of Israel, 14 Kaplan St, Petach Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Pleniceanu
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
- The Nephrology Research Lab, Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Israel
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6
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Retrospective evaluation of children with unilateral renal agenesis. Pediatr Nephrol 2021; 36:2847-2855. [PMID: 33723672 DOI: 10.1007/s00467-021-05027-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Children born with unilateral renal agenesis (URA) are thought to have a risk of developing hypertension, proteinuria, and progressive chronic kidney disease (CKD). The present study aimed to evaluate the long-term prognosis and clinical characteristics of children with URA. METHODS The study included 171 patients aged < 18 years diagnosed as URA who were followed-up for ≥ 1 year and 121 healthy controls matched for age, gender, and BMI. RESULTS Median age at diagnosis was 2 years (IQR: 1 month-16 years) and the incidence of URA in males (65.4%) was higher than in females. Among the patients, 21 (12.2%) had other urinary system anomalies. It was noted that 2.3% of the patients had proteinuria, 15.2% had hyperfiltration, and 2.9% had CKD. Hypertension based on ambulatory blood pressure monitoring (ABPM) was diagnosed in 18 (10.5%) of the patients, of whom 10 had masked hypertension. Diastolic blood pressure in the URA patients was significantly higher than in the healthy controls. The incidence of hypertension and CKD was significantly higher in the patients with other urinary system anomalies. CONCLUSIONS Patients with a single functional kidney should be periodically evaluated throughout their lifetime for urine protein, blood pressure, and kidney functions. The most remarkable finding of this study is the importance of the use of ABPM for evaluating blood pressure in pediatric URA patients, especially for the detection of masked hypertension and the non-dipper phenomenon, which cannot be achieved with office blood pressure measurement.
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7
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Jawa NA, Rosenblum ND, Radhakrishnan S, Pearl RJ, Levin L, Matsuda-Abedini M. Reducing Unnecessary Imaging in Children With Multicystic Dysplastic Kidney or Solitary Kidney. Pediatrics 2021; 148:peds.2020-035550. [PMID: 34230093 DOI: 10.1542/peds.2020-035550] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children with isolated unilateral multicystic dysplastic kidney (MCDK) or congenital solitary kidney (CSK) undergo serial renal ultrasonography with variable frequency until they are transitioned to adult care. A growing body of literature suggests the value of frequent ultrasonography in this population is limited, providing no benefit to overall outcomes. Despite emerging evidence, ultrasound remains overused, resulting in avoidable health care expenditures and unnecessary use of resources. With our initiative, we aimed to improve quality of care by reducing avoidable ultrasounds in these children. METHODS This was a single-center, prospective, interrupted time series of children <18 years with ultrasound-confirmed isolated unilateral MCDK or CSK in the outpatient nephrology clinic to evaluate the effect of a decision-making algorithm on the proportion of children receiving an avoidable ultrasound. An algorithm depicting a consensus, evidence-based protocol for managing pediatric MCDK or CSK was refined through content expert feedback and usability testing to standardize frequency of ultrasonography. Ultrasounds were deemed necessary after birth, at 6 months, and at 2, 5, 10, and 15 years. Differences pre- and postintervention were determined by using a U chart and t and F tests for significance. RESULTS The algorithm resulted in a 47% reduction (P < .001) in the proportion of avoidable ultrasounds ordered in children with MCDK and CSK. This reduction was sustainable over a 6-month period and would result in at least $46 000 annual savings. CONCLUSIONS Introduction of a clinical decision-making algorithm was associated with a reduction in avoidable ultrasound testing. Improving adherence across providers may allow for an even more pronounced reduction.
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Affiliation(s)
- Natasha A Jawa
- Division of Nephrology and .,Department of Pediatrics, Faculty of Medicine
| | - Norman D Rosenblum
- Division of Nephrology and.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Seetha Radhakrishnan
- Division of Nephrology and.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel J Pearl
- Division of Nephrology and.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Leo Levin
- Division of Nephrology and.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mina Matsuda-Abedini
- Division of Nephrology and.,Developmental & Stem Cell Biology Program, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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Hutchinson KA, Halili L, Guerra A, Geier P, Keays M, Guerra L. Renal function in children with a congenital solitary functioning kidney: A systematic review. J Pediatr Urol 2021; 17:556-565. [PMID: 33752977 DOI: 10.1016/j.jpurol.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Abnormal renal development that results in lack of function or development of one of two kidneys is known as congenital solitary functioning kidney (CSFK). Two well characterized sub-categories of CFSK are unilateral renal agenesis (URA) and multicystic dysplastic kidney (MCDK). This systematic review sought to evaluate the change in renal function in children ≤18 years old with a CSFK as a result of URA or MCDK. METHODS A literature search in MEDLINE and Embase was conducted (1946 to July 13, 2020). All relevant articles were retrieved and evaluated based on pre-selected criteria by two independent researchers. Data was then extracted from variables of interest and conflicts were resolved by a third researcher. The primary outcome was renal function, and the secondary outcomes were proteinuria and hypertension. RESULTS Forty-five studies were included, of which 49% (n = 22) were retrospective and/or 58% (n = 26) were cohort studies. A combined total of 2148 and 885 patients were diagnosed with MCDK or URA, respectively. The proportion of children with worsened renal function at follow-up was found to be 8.4% (95% CI: 5.2%-13.4%). Among the studies reporting renal function as a group mean or median at follow-up, 84% (21/25) had a GFR/CrCl above 90 (mL/min/1.73 m2/ml/min). In terms of secondary outcomes, the proportion of children with proteinuria and hypertension was found to be 10.1% (95% CI: 6.9%-14.6%) and 7.4% (95% CI: 5.0%-10.9%), respectively. CONCLUSION The risk of developing proteinuria (10.1%), hypertension (7.4%), and/or worsened renal function (8.4%) for children with CFSK as a result of MCDK or URA is low. However, the level of evidence in the literature is weak. Further research is needed to identify the predisposing factors that may differentiate the small subset of children with CSFK at a higher risk of developing adverse renal outcomes.
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Affiliation(s)
- Kelly Ann Hutchinson
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Lyra Halili
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Andre Guerra
- Department of Chemical Engineering, McGill University, Montreal, Quebec, Canada
| | - Pavel Geier
- Department of Pediatrics, Division of Nephrology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Melise Keays
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luis Guerra
- Department of Surgery, Division of Urology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
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Yel S, Günay N, Pınarbaşı AS, Balaban AG, Caferoğlu Z, Dursun İ, Poyrazoğlu MH. Do children with solitary or hypofunctioning kidney have the same prevalence for masked hypertension? Pediatr Nephrol 2021; 36:1833-1841. [PMID: 33459937 DOI: 10.1007/s00467-020-04896-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/12/2020] [Accepted: 12/08/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Having a low nephron number is a well-known risk factor for hypertension. There is an inverse relationship between the filtration surface area and systemic hypertension. A significant percentage of masked hypertension can be detected in children with nephron loss by ambulatory blood pressure monitoring (ABPM). METHODS We prospectively investigated ABPM results of children having reduced kidney mass with normal office blood pressures (BPs) and kidney function. Forty-three children with congenital solitary kidney (group 1), 11 children with acquired solitary kidney (group 2), and 76 children with hypofunctioning kidney (group 3) were compared with age, gender, and BMI-matched healthy control group (group 4). The dietary salt intake of 76 patients was evaluated as salt equivalent (g/day). The primary endpoint was change from baseline in mean 24-h ABPM variables and the proportion of patients with masked hypertension when assessed by ABPM. RESULTS The masked hypertension ratio of all patients was 12.3% when assessed with ABPM. Night hypertension was significantly higher in all patient groups than in the control group (p = 0.01). Diastolic BP loads of groups 1 and 3 were higher than in controls (p = 0.024). Systolic BP loads were higher only in group 1 than in the control group (p = 0.003). The dietary salt equivalent of patients in group 1 correlated positively with 24-h SBP and mean arterial pressure (MAP) values. Patients with excessive dietary salt intake in group 1 had a significantly higher diastolic BP load than those without excessive salt intake in group 1 (p = 0.002). CONCLUSIONS Masked hypertension can be seen in children with a solitary kidney or when one of the kidneys is hypofunctioning. Systolic BP loads are higher in children with congenital solitary kidney, and salt intake correlates with systolic BP profiles especially in those. Our results suggest that being born with a congenital solitary kidney increases predisposition to hypertension and salt sensitivity.
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Affiliation(s)
- Sibel Yel
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Neslihan Günay
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Aynur Gencer Balaban
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zeynep Caferoğlu
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - İsmail Dursun
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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10
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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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11
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Arterial hypertension and cystatin C during neonatal physiologic dehydration. J Hum Hypertens 2021; 36:554-560. [PMID: 33935283 DOI: 10.1038/s41371-021-00541-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/27/2021] [Accepted: 04/14/2021] [Indexed: 11/09/2022]
Abstract
A reduced nephron number may play a role in the pathogenesis of arterial hypertension (AH), and it is well recognized that individual nephron endowment is widely variable. However, nephrons count is technically impossible in vivo. Based on the observation that subjects with a reduced nephron mass exhibit an increase in renal functional biomarkers during acute dehydration, we hypothesized that cystatin C concentration during neonatal physiological dehydration could identify subjects with reduced nephron endowment. This is a prospective, observational, cohort study enrolling healthy, caucasian, term neonates born after an uneventful pregnancy. Two groups of newborns were compared: neonates born to fathers on antihypertensive treatment (HF) versus those born to proven normotensive fathers older than 40 years of age (NF). Enrolled newborns underwent cystatin C determination at the time of newborn screening. Forty newborns with HF and 80 with NF were enrolled. No differences in baseline characteristics were observed between the two groups except for the number of hypertensive grandparents higher among newborns to HF (47.8% vs. 21.1%; p: 0.001). Cystatin C was significantly higher in newborns with HF (1.62 ± 0.30 mg/L vs 1.41 ± 0.27 mg/L; p < 0.001). Linear regression analysis corrected for confounders confirmed that paternal hypertension was the only variable significantly associated with high cystatin C level during post-natal dehydration. Besides offering new insights on the pathogenesis of familial hypertension, our results support the specific role of nephron endowment and suggest the possibility of identifying subjects at risk for reduced nephron endowment as early as at birth.
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12
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Balkı HG, Turhan P, Candan C. Evaluation of renal injury in children with a solitary functioning kidney. Turk Arch Pediatr 2021; 56:219-223. [PMID: 34104912 DOI: 10.5152/turkarchpediatr.2021.20095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
Objective Children with a solitary functioning kidney have an increased risk of developing renal injury that is hypothesized to be caused by glomerular hyperfiltration. In this study, we aimed to assess the early signs of renal injury and ambulatory blood pressure profiles in children with a solitary functioning kidney. Materials and Methods Data of children with normal office blood pressure measurement and a solitary functioning kidney were reviewed (serum creatinine and urine albumin and β2 microglobulin excretions), and 23 age-, weight-, and height-matched healthy children were considered as a control group. The size of the kidney was measured by renal ultrasound, and the presence of compensatory hypertrophy was calculated for all the subjects. Also, the subjects were additionally assessed for blood pressure (BP) pattern and the presence of hypertension by 24-hambulatory blood pressure monitoring. Results The solitary functioning kidney demonstrated compensatory hypertrophy in 36 out of the patients (86%) at a mean age of 14.0 (SD 3.0) years. Increased urine albumin and β2 microglobulinuria, which are signs of kidney damage, were found in 7 (17%) and 5(12%) patients. Compared with the controls, patients had significantly higher mean blood pressure standard deviation scores (p>0,001), and ambulatory blood pressure monitoring identified masked hypertension in 7 (17%) children and prehypertension in 6 (14%) patients. Therefore, renal injury, defined as the presence of hypertension and/or albuminuria and/or β2 microglobulinuria and/or hypertension, was present in 36% of all children with a solitary functioning kidney. Conclusion Children with a solitary functioning kidney need prolonged follow-up to detect early signs of renal injury and prevent end-organ damage later in life. Ambulatory blood pressure monitoring is an essential tool in the diagnosis and clinical management of solitary functioning kidney patients.
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Affiliation(s)
- Hanife Gül Balkı
- Department of Child Health and Diseases, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Pınar Turhan
- Division of Pediatric Nephrology, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
| | - Cengiz Candan
- Division of Pediatric Nephrology, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey
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13
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Groen in 't Woud S, Westland R, Feitz WF, Roeleveld N, van Wijk JA, van der Zanden LF, Schreuder MF. Clinical Management of Children with a Congenital Solitary Functioning Kidney: Overview and Recommendations. EUR UROL SUPPL 2021; 25:11-20. [PMID: 34337499 PMCID: PMC8317823 DOI: 10.1016/j.euros.2021.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 11/25/2022] Open
Abstract
CONTEXT A congenital solitary functioning kidney (cSFK) is a common developmental defect that predisposes to hypertension and chronic kidney disease (CKD) as a consequence of hyperfiltration. Every urologist takes care of patients with a cSFK, since some will need lifelong urological care or will come with clinical problems or questions to an adult urologist later in life. OBJECTIVE We aim to provide clear recommendations for the initial clinical management and follow-up of children with a cSFK. EVIDENCE ACQUISITION PubMed and EMBASE were searched to identify relevant publications, which were combined with guidelines on related topics and expert opinion. EVIDENCE SYNTHESIS Initially, cSFK diagnosis should be confirmed and risk factors for kidney injury should be identified using ultrasound. Although more research into early predictors of kidney injury is needed, additional congenital anomalies of the kidney or urinary tract and absence of compensatory kidney hypertrophy have repeatedly been associated with a worse prognosis. The role of voiding cystourethrography and antibiotic prophylaxis remains controversial, and is complicated by the exclusion of children with a cSFK from studies. A yearly follow-up for signs of kidney injury is recommended for children with a cSFK. As masked hypertension is prevalent, annual ambulatory blood pressure measurement should be considered. During puberty, an increasing incidence of kidney injury is seen, indicating that long-term follow-up is necessary. If signs of kidney injury are present, angiotensin converting enzyme inhibitors are the first-line drugs of choice. CONCLUSIONS This overview points to the urological and medical clinical aspects and long-term care guidance for children with a cSFK, who are at risk of hypertension and CKD. Monitoring for signs of kidney injury is therefore recommended throughout life. Large, prospective studies with long-term follow-up of clearly defined cohorts are still needed to facilitate more risk-based and individualized clinical management. PATIENT SUMMARY Many children are born with only one functioning kidney, which could lead to kidney injury later in life. Therefore, a kidney ultrasound is made soon after birth, and other investigations may be needed as well. Urologists taking care of patients with a solitary functioning kidney should realize the long-term clinical aspects, which might need medical management.
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Affiliation(s)
- Sander Groen in 't Woud
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Pediatric Nephrology, Radboudumc Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Rik Westland
- Department of Pediatric Nephrology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Wout F.J. Feitz
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Joanna A.E. van Wijk
- Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Loes F.M. van der Zanden
- Department for Health Evidence, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Michiel F. Schreuder
- Department of Pediatric Nephrology, Radboudumc Amalia Children’s Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
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Sugimoto K, Enya T, Joh K, Miyazaki K, Miyazawa T, Ohshima R, Marutani S, Tsukasa T, Okada M. Pathophysiological clinical features of an infant with hypertension secondary to multicystic dysplastic kidney: a case report. BMC Nephrol 2021; 22:55. [PMID: 33546619 PMCID: PMC7866690 DOI: 10.1186/s12882-021-02249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association of hypertension with congenital renal hypoplasia has been established. We report a case of an infant who underwent nephrectomy for hypertension. CASE PRESENTATION Magnetic resonance imaging for the mother revealed fetal renal masses, and fetal multicystic dysplastic kidney was suspected. Following birth, the baby developed hypertension. Numerous investigations revealed that the left kidney was non-functional, and she was initiated on benazepril hydrochloride. However, because the drug response was poor, the left kidney was removed at the age of 7 months. Examination of the renal specimen revealed abrupt transition from normal to atrophic cortex with lobar atrophy and cysts. Tubular atrophy, marked abnormal blood vessels with wall thickening, gathered immature glomeruli, and parenchymal destruction were observed. Renin was partially localized in the proximal tubules and the parietal epithelium of the Bowman's capsule in the immature glomeruli. We speculated that an abnormal vascular structure and irregular renin localizations may be the cause of hypertension. Serum renin and aldosterone levels gradually reduced post-surgery, reaching normal levels on the 90th postoperative day. A long follow-up is needed due to the possibility of the child developing hypertension in the future. CONCLUSION This is a case of an infant with MCDK, which discusses the clinicopathological features based on the pathophysiological analysis, including renin evaluation.
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Affiliation(s)
- Keisuke Sugimoto
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan.
| | - Takuji Enya
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Kensuke Joh
- Department of Pathology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kohei Miyazaki
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Tomoki Miyazawa
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Rina Ohshima
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Satoshi Marutani
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Takemura Tsukasa
- Department of Pediatrics, Kushimoto Municipality Hospital, Higashimuro-gun, Wakayama, Japan
| | - Mitsuru Okada
- Department of Pediatrics, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
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15
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Tumor Necrosis Factor-Like Weak Inducer of Apoptosis and Selected Cytokines-Potential Biomarkers in Children with Solitary Functioning Kidney. J Clin Med 2021; 10:jcm10030497. [PMID: 33535375 PMCID: PMC7866991 DOI: 10.3390/jcm10030497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 11/17/2022] Open
Abstract
This study was performed to explore serum tumor necrosis factor-like weak inducer of apoptosis (TWEAK) and its dependent cytokines urinary excretion: monocyte chemoattractant protein-1 (MCP-1) and regulated on activation, normal T cell expressed and secreted chemokine (RANTES) with their relation to the kidney function parameters in children with solitary functioning kidney (SFK). The study included 80 children and adolescents (median age 9.75 year) with congenital and acquired (after surgical removal) SFK. Serum TWEAK and urinary MCP-1 and RANTES levels were significantly higher in SFK patients (p < 0.05). The serum TWEAK was positively related to serum creatinine (r = 0.356; p < 0.001). Moreover, in SFK the receiver operating characteristic analyses revealed good diagnostic profile for serum TWEAK with AUC (Area Under The Curve)—0.853, uRANTES—0.757, and for RANTES/cr.: AUC—0.816. Analysis carried out to identify children with impaired renal function (albuminuria and/or decreased estimated glomerular filtration rate < 90 mL/min/1.73 m2 and/or hypertension) showed good profile for TWEAK (AUC—0.79) and quite good profile for uRANTES and RANTES/cr. (AUC 0.66 and 0.631, respectively). This is the first study investigating serum TWEAK and urinary excretion of MCP-1 and RANTES together in children with SFK. Obtained results indicate that TWEAK and RANTES may serve as potential markers of renal impairment.
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16
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Kasap-Demir B, Soyaltın E, Arslansoyu-Çamlar S, Alparslan C, Alaygut D, Yavaşcan Ö, Demircan T, Mutlubaş F, Karadeniz C. Cardiovascular risk assessment in children and adolescents with congenital solitary kidneys. J Clin Hypertens (Greenwich) 2021; 23:245-252. [PMID: 33387392 PMCID: PMC8030084 DOI: 10.1111/jch.14159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/30/2022]
Abstract
Patients with solitary kidneys (SKs) are at risk of hypertension (HT) and associated end-organ damage. The authors aimed to evaluate whether children with congenital SKs (CSKs) have higher office, ambulatory, or central blood pressure (BP), increased arterial stiffness or left ventricular mass index, or any risk for arrhythmia. With this purpose, patients with CSK and healthy controls being followed up between January 2018 and June 2019 were enrolled in the study. Demographic, biochemical, and office blood pressure (BP) data were recorded. Then, ambulatory blood pressure monitoring (ABPM) and measurements of central BP (cBP), pulse wave velocity (PWV), and augmentation index (AIx@75) were obtained. Ventricular repolarization parameters were acquired by 12-lead electrocardiography. Left ventricular mass index (LVMI) and abdominal aortic stiffness parameters including strain, pressure strain elastic modulus (Ep), and normalized Ep (Ep*) were calculated with echocardiographic measurements. Finally, 36 children with CSK and 36 healthy controls were included. Serum creatinine, uric acid, total cholesterol levels, ABPM parameters, cBP levels, and PWV values were significantly higher, and eGFR levels were significantly lower in the CSK group. VR parameters, abdominal aortic stiffness indices, and LVMI were similar between the groups. CSK increased the risk of HT in ABPM (HTABPM ) by 6 times. PWV was significantly correlated with Ep and Ep* in cases with CSK. Determination of cBP and PWV along with 24-hour ABPM would be a useful tool in children with CSK.
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Affiliation(s)
- Belde Kasap-Demir
- Department of Pediatric Nephrology, İzmir Katip Çelebi University, İzmir, Türkiye.,Department of Pediatric Nephrology, University Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Eren Soyaltın
- Department of Pediatric Nephrology, University Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Seçil Arslansoyu-Çamlar
- Department of Pediatric Nephrology, University Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Caner Alparslan
- Department of Pediatric Nephrology, University Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Demet Alaygut
- Department of Pediatric Nephrology, University Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Önder Yavaşcan
- Department of Pediatric Nephrology, University Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Tülay Demircan
- Department of Pediatric Cardiology, University of Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Fatma Mutlubaş
- Department of Pediatric Nephrology, University Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye
| | - Cem Karadeniz
- Department of Pediatric Cardiology, University of Health Sciences İzmir Tepecik Training and Research Hospital, İzmir, Türkiye.,Department of Pediatric Cardiology, İzmir Katip Çelebi University, İzmir, Türkiye
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17
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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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18
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La Scola C, Marra G, Ammenti A, Pasini A, Taroni F, Bertulli C, Morello W, Ceccoli M, Mencarelli F, Guarino S, Puccio G, Montini G. Born with a solitary kidney: at risk of hypertension. Pediatr Nephrol 2020; 35:1483-1490. [PMID: 32211991 PMCID: PMC7316689 DOI: 10.1007/s00467-020-04535-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 03/02/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Subjects with a congenital solitary kidney (CSK) are believed to be at risk of hypertension due to their low number of nephrons. However, as CSK is a congenital abnormality of the kidney or urinary tract (CAKUT), subtle dysplastic changes contributing to hypertension cannot be excluded. METHODS We retrospectively compared office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) between two groups of children with CAKUT, aged 6-18 years: Group A with a CSK and Group B with two kidneys. All had normal renal parenchyma on scintigraphy and normal renal function. OBP and mean systolic and diastolic 24-h, daytime and nighttime ambulatory BP records were analyzed. The distribution of OBP and APBM as continuous values and the prevalence of hypertension (ambulatory/severe ambulatory or masked hypertension) in the two groups were compared. RESULTS There were 81 patients in Group A and 45 in Group B. Median OBP standard deviation scores were normal in both groups, without significant differences. Median ABPM standard deviation scores, although normal, were significantly higher in Group A and the prevalence of hypertension was higher (ambulatory/severe ambulatory or masked) (33.3 vs. 13.3%, p = 0.019), mainly because of the greater occurrence of masked hypertension. CONCLUSIONS Our data show that a CSK per se can be associated with an increased risk of hypertension from the pediatric age. Therefore, ABPM, which has proved valuable in the screening of hypertension, is warranted in children with a CSK, even if laboratory and imaging assessment is otherwise normal.
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Affiliation(s)
- Claudio La Scola
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | - Giuseppina Marra
- grid.414818.00000 0004 1757 8749Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Anita Ammenti
- Unità Polispecialistica Pediatrica, Ambulatorio Medi-Saluser, Parma, Italy
| | - Andrea Pasini
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | - Francesca Taroni
- grid.414818.00000 0004 1757 8749Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Cristina Bertulli
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | - William Morello
- grid.414818.00000 0004 1757 8749Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Martina Ceccoli
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | - Francesca Mencarelli
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy
| | - Stefano Guarino
- Nephrology and Dialysis Unit, Department of Pediatrics, Azienda Ospedaliero Universitaria Sant’Orsola-Malpighi, Bologna, Italy ,grid.4691.a0000 0001 0790 385XPresent Address: Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania L. Vanvitelli, Naples, Italy
| | | | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico di Milano, Milan, Italy. .,Giuliana and Bernardo Caprotti Chair of Pediatrics, Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
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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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20
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Kim S, Chang Y, Lee YR, Jung HS, Hyun YY, Lee KB, Joo KJ, Yun KE, Shin H, Ryu S. Solitary kidney and risk of chronic kidney disease. Eur J Epidemiol 2019; 34:879-888. [PMID: 31025238 DOI: 10.1007/s10654-019-00520-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/13/2019] [Indexed: 01/10/2023]
Abstract
The renal outcome of solitary kidney remains controversial. We examined the longitudinal association of congenital or acquired solitary kidney with the development of chronic kidney disease (CKD). A cohort study was performed involving 271,171 Korean men and women free of CKD at baseline who underwent a health screening program and who were followed annually or biennially for an average of 5.4 years. Solitary kidney was determined based on ultrasonographic findings. CKD was defined as an estimated glomerular filtration rate of < 60 ml/min/1.73 m2 and/or the presence of proteinuria in two or more consecutive visits. During 1,472,519.6 person-years of follow-up, 2989 participants developed CKD (incidence rate: 2.0 per 1000 person-years). After adjustment for potential confounders, the aHR (95% CIs) for incident CKD comparing solitary kidney to the control was 3.26 (1.63-6.54). In analyses of cause-specific solitary kidney, aHR (95% CIs) for CKD comparing unilateral nephrectomy and congenital solitary kidney to the control were 6.18 (2.31-16.49) and 2.22 (0.83-5.92), respectively. The association between solitary kidney and CKD was stronger in men. Having a solitary kidney was independently associated with an increased risk of CKD development. Therefore, preventive strategies for reducing the risk of CKD are required in individuals with a solitary kidney.
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Affiliation(s)
- Seolhye Kim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul, 04514, South Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Young Rae Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun-Suk Jung
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Youl Hyun
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyu-Beck Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kwan Joong Joo
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Eun Yun
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hocheol Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul, 04514, South Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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21
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Poggiali IV, Simões E Silva AC, Vasconcelos MA, Dias CS, Gomes IR, Carvalho RA, Oliveira MCL, Pinheiro SV, Mak RH, Oliveira EA. A clinical predictive model of renal injury in children with congenital solitary functioning kidney. Pediatr Nephrol 2019; 34:465-474. [PMID: 30324507 DOI: 10.1007/s00467-018-4111-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/13/2018] [Accepted: 10/02/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Solitary functioning kidney (SFK) is an important condition in the spectrum of congenital anomalies of the kidney and urinary tract. The aim of this study was to describe the risk factors for renal injury in a cohort of patients with congenital SFK. METHODS In this retrospective cohort study, 162 patients with SFK were systematically followed up (median, 8.5 years). The primary endpoint was time until the occurrence of a composite event of renal injury, which includes proteinuria, hypertension, and chronic kidney disease (CKD). A predictive model was developed using Cox proportional hazards model and evaluated by c statistics. RESULTS Among 162 children with SFK included in the analysis, 132 (81.5%) presented multicystic dysplastic kidney, 20 (12.3%) renal hypodysplasia, and 10 (6.2%) unilateral renal agenesis. Of 162 patients included in the analysis, 10 (6.2%) presented persistent proteinuria, 11 (6.8%) had hypertension, 9 (5.6%) developed CKD stage ≥ 3, and 18 (11%) developed the composite outcome. After adjustment by the Cox model, three variables remained as independent predictors of the composite event: creatinine (HR, 3.93; P < 0.001), recurrent urinary tract infection (UTI) (HR, 5.05; P = 0.002), and contralateral renal length at admission (HR, 0.974; P = 0.002). The probability of the composite event at 10 years of age was estimated as 3%, 11%, and 56% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). CONCLUSION Our findings have shown an overall low risk of renal injury for most of infants with congenital SFK. Nevertheless, our prediction model enabled the identification of a subgroup of patients with an increased risk of renal injury over time.
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Affiliation(s)
- Isabel V Poggiali
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Cristina Simões E Silva
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Mariana A Vasconcelos
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Cristiane S Dias
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Izabella R Gomes
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Rafaela A Carvalho
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Maria Christina L Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Sergio V Pinheiro
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Robert H Mak
- Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA
| | - Eduardo A Oliveira
- Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil. .,Division of Pediatric Nephrology, Rady Children's Hospital San Diego, University of California, San Diego, La Jolla, CA, USA.
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22
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Urisarri A, Gil M, Mandiá N, Aldamiz-Echevarría L, Iria R, González-Lamuño D, Couce ML. Retrospective study to identify risk factors for chronic kidney disease in children with congenital solitary functioning kidney detected by neonatal renal ultrasound screening. Medicine (Baltimore) 2018; 97:e11819. [PMID: 30095653 PMCID: PMC6133615 DOI: 10.1097/md.0000000000011819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
To evaluate the prognostic significance of factors frequently associated with a reduction in renal mass, such as prematurity, low birth weight, and congenital anomalies of kidney and urinary tract (CAKUT), in patients with solitary functioning kidney (SFK) and investigate signs of early renal injury due to glomerular hyperfiltration damage or dysplasia in the remaining kidney.Retrospective observational study of congenital SFK diagnosed and followed at a tertiary care hospital over a period of 10 years in which 32,900 newborns underwent routine neonatal abdominal ultrasound screening. We analyzed age at diagnosis, sex, gestational age, anthropometric measurements at birth and prenatal and neonatal ultrasound findings, in addition to follow-up data corresponding to imaging findings (ultrasound, micturating cystourethrography, dimercaptosuccinic acid renal, and scintigraphy), ipsilateral CAKUT, compensatory hypertrophy, and renal injury in the form of albuminuria, blood pressure, and estimated glomerular filtration rate (eGFR).In total, 128 congenital SFK cases were detected (1 per 257 live births). Of these, 117 (91.4%) were diagnosed by neonatal ultrasound screening and 44.5% of these had been previously identified by prenatal ultrasound. Neonatal ultrasound had a specificity of 100% and a sensitivity of 92.1%. Forty-five patients (35.2%) had ipsilateral CAKUT and the most common type was urinary collecting system anomalies (75.5%). Over a median follow-up of 6.3 years (1-10 years), compensatory renal hypertrophy was observed in 81 patients (63.7%), most of whom had ipsilateral CAKUT (76.1% vs 56.6% of patients without ipsilateral CAKUT). Albuminuria and hypertension were observed in 3.12% and 5% of patients, respectively, and both were associated with ipsilateral CAKUT (P < .05). In addition, 75% of albuminuria cases (P = .031), 83.3% of hypertension cases (P = .004), and 100% of decreased eGFRcases (P = .031) were significantly associated with CAKUT (renal parenchymal anomaly category), being the strongest predictor of GFR the presence or absence of CAKUT.Neonatal ultrasound screening is useful for the early diagnosis of SFK. The presence of ipsilateral CAKUT should be evaluated in all patients with SFK as congenital anomalies of the renal parenchyma are associated with a poorer prognosis. Because morbidity from CAKUTs may not develop until adulthood, patients should be closely followed throughout life.
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Affiliation(s)
- Adela Urisarri
- Neonatal Service. Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana
| | - Marta Gil
- Pediatric Nephrology Unit, Santiago de Compostela University Hospital, Santiago de Compostela
| | - Natalia Mandiá
- Neonatal Service. Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana
| | | | - Roca Iria
- Neonatal Service. Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana
| | - Domingo González-Lamuño
- Department of Pediatrics, University Hospital Marqués de Valdecilla-Universidad de Cantabria, Santander, Spain
| | - María-Luz Couce
- Neonatal Service. Department of Pediatrics, Santiago de Compostela University Hospital, IDIS (Health Research Institute of Santiago de Compostela), CIBERER, Travesia Choupana
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23
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Lubrano R, Gentile I, Falsaperla R, Vitaliti G, Marcellino A, Elli M. Evolution of blood pressure in children with congenital and acquired solitary functioning kidney. Ital J Pediatr 2017; 43:43. [PMID: 28449720 PMCID: PMC5408435 DOI: 10.1186/s13052-017-0359-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 04/13/2017] [Indexed: 01/13/2023] Open
Abstract
Background It is not yet clear if blood pressure and renal function changes evolve differently in children with a congenital or acquired solitary functioning kidney. This study aims to assess if there are any differences between these two types of solitary kidney patients. Methods Current research is a retrospective study assessing the evolution of glomerular filtration rate, proteinuria, and blood pressure in clinical records of 55 children with a solitary functioning kidney (37 congenital and 18 acquired). We used the medical records of children who had been assisted, in our unit of pediatric nephrology, for a period of 14 years (168 months), from the time of diagnosis, between January/1997 and December/2015. Results During the study period, glomerular filtration rate (T0 128.89 ± 32.24 vs T14 118.51 ± 34.45 ml/min/1.73 m2, p NS) and proteinuria (T0 85.14 ± 83.13 vs T14 159.03 ± 234.66 mg/m2/die, p NS) demonstrated no significant change. However, after 14 years of follow-up 76.4% of patients had increased levels of arterial hypertension with values over the 90th percentile for gender, age, and height. Specifically, children with an acquired solitary functioning kidney mainly developed hypertension [T0 2/17 (12%) vs T14 9/17 (52.9%) p < 0.025], whereas children with a congenital solitary functioning kidney mainly developed pre-hypertension [T0 3/38 (7.9%) vs T14 17/38 (44.7%) p < 0.0005]. Conclusions The renal function of children with solitary functioning kidneys remains stable during a follow-up of 14 years. However, these children should be carefully monitored for their tendency to develop arterial blood pressure greater than the 90th percentile for gender, age, and height.
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Affiliation(s)
- Riccardo Lubrano
- Pediatric Department, Pediatric Nephrology Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Isotta Gentile
- Pediatric Department, Pediatric Nephrology Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Raffaele Falsaperla
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, Catania, Italy
| | - Giovanna Vitaliti
- Pediatric Department, Pediatric Nephrology Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Alessia Marcellino
- Pediatric Department, Pediatric Nephrology Unit, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Marco Elli
- DiBiC-Biomedical and Clinic Science Department, "Luigi Sacco" - University of Milan, Milan, Italy
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24
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Yazici R, Guney İ, Altintepe L, Yazici M. Does the serum uric acid level have any relation to arterial stiffness or blood pressure in adults with congenital renal agenesis and/or hypoplasia? Clin Exp Hypertens 2017; 39:145-149. [PMID: 28287880 DOI: 10.1080/10641963.2016.1210630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The relationship between serum uric acid and arterial stiffness or blood pressure is not clear. The serum uric acid level and its association with cardiovascular risk is not well known in patients with reduced renal mass. We aimed to investigate the relation between serum uric acid levels and arterial stiffness and also blood pressure in patients with congenital renal agenesis and/or hypoplasia. MATERIAL AND METHODS In this single center, cross-sectional study, a total of 55 patients (39 (% 70.9) with unilateral small kidney and 16 (%29.1) with renal agenesis) were included. The median age was 35 (21-50) years. The study population was divided into tertiles of serum uric acid (according to 2.40-3.96, 3.97-5.10, and 5.11-9.80 mg/dl cut-off values of serum uric acid levels). Official and 24-h ambulatory non-invasive blood pressures of all patients were measured. The arterial stiffness was assessed by pulse wave velocity (PWV). RESULTS PWV values were increased from first to third tertile (5.5 ± 0.6, 5.7 ± 0.8, 6.1 ± 0.7, respectively), but this gradual increase between tertiles did not reach significance. Linear regression analyses showed a positive correlation between serum uric acid levels and PWV (β = 0.40, p = 0.010), but no correlation was found between uric acid and daytime systolic blood pressure (β = 0.24, p = 0.345). CONCLUSION In congenital renal agenesis/hypoplasia, the serum uric acid level was positively correlated with arterial stiffness, but there was no correlation with blood pressure.
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Affiliation(s)
- Raziye Yazici
- a Konya Education and Research Hospital , Department of Nephrology , Konya , Turkey
| | - İbrahim Guney
- a Konya Education and Research Hospital , Department of Nephrology , Konya , Turkey
| | - Lutfullah Altintepe
- a Konya Education and Research Hospital , Department of Nephrology , Konya , Turkey
| | - Mehmet Yazici
- b Necmettin Erbakan University , Meram Medical School, Department of Cardiology , Konya , Turkey
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25
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Wang X, Garrett MR. Nephron number, hypertension, and CKD: physiological and genetic insight from humans and animal models. Physiol Genomics 2017; 49:180-192. [PMID: 28130427 DOI: 10.1152/physiolgenomics.00098.2016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The kidneys play a vital role in the excretion of waste products and the regulation of electrolytes, maintenance of acid-base balance, regulation of blood pressure, and production of several hormones. Any alteration in the structure of the nephron (basic functional unit of the kidney) can have a major impact on the kidney's ability to work efficiently. Progressive decline in kidney function can lead to serious illness and ultimately death if not treated by dialysis or transplantation. While there have been numerous studies that implicate lower nephron numbers as being an important factor in influencing susceptibility to developing hypertension and chronic kidney disease, a direct association has been difficult to establish because of three main limitations: 1) the large variation in nephron number observed in the human population; 2) no established reliable noninvasive methods to determine nephron complement; and 3) to date, nephron measurements have been done after death, which doesn't adequately account for potential loss of nephrons with age or disease. In this review, we will provide an overview of kidney structure/function, discuss the current literature for both humans and other species linking nephron deficiency and cardio-renal complications, as well as describe the major molecular signaling factors involved in nephrogenesis that modulate variation in nephron number. As more detailed knowledge about the molecular determinants of nephron development and the role of nephron endowment in the cardio-renal system is obtained, it will hopefully provide clinicians the ability to accurately identify people at risk to develop CKD/hypertension and lead to a shift in patient care from disease treatment to prevention.
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Affiliation(s)
- Xuexiang Wang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Michael R Garrett
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, Mississippi; and .,Department of Medicine (Nephrology) and Pediatrics (Genetics), University of Mississippi Medical Center, Jackson, Mississippi
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26
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Sarhan OM, Albedaiwi K, Al Harbi B, Al Otay A, Al Ghanbar M, Nakshabandi Z. Unilateral Renal Agenesis: Necessity of Postnatal Evaluation in a Contemporary Series. Urology 2016; 98:144-148. [DOI: 10.1016/j.urology.2016.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 11/26/2022]
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Tancredi G, Lambiase C, Favoriti A, Ricupito F, Paoli S, Duse M, De Castro G, Zicari AM, Vitaliti G, Falsaperla R, Lubrano R. Cardiorespiratory fitness and sports activities in children and adolescents with solitary functioning kidney. Ital J Pediatr 2016; 42:43. [PMID: 27117183 PMCID: PMC4847270 DOI: 10.1186/s13052-016-0255-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An increasing number of children with chronic disease require a complete medical examination to be able to practice physical activity. Particularly children with solitary functioning kidney (SFK) need an accurate functional evaluation to perform sports activities safely. The aim of our study was to evaluate the influence of regular physical activity on the cardiorespiratory function of children with solitary functioning kidney. METHOD Twenty-nine patients with congenital SFK, mean age 13.9 ± 5.0 years, and 36 controls (C), mean age 13.8 ± 3.7 years, underwent a cardiorespiratory assessment with spirometry and maximal cardiopulmonary exercise testing. All subjects were divided in two groups: sedentary (S) and trained (T) patients, by means of a standardized questionnaire about their weekly physical activity. RESULTS We found that mean values of maximal oxygen consumption (VO2max) and exercise time (ET) were higher in T subjects than in S subjects. Particularly SFK-T presented mean values of VO2max similar to C-T and significantly higher than C-S (SFK-T: 44.7 ± 6.3 vs C-S: 37.8 ± 3.7 ml/min/kg; p < 0.0008). We also found significantly higher mean values of ET (minutes) in minutes in SFK-T than C-S subjects (SFK-T: 12.9 ± 1.6 vs C-S: 10.8 ± 2.5 min; p <0.02). CONCLUSION Our study showed that regular moderate/high level of physical activity improve aerobic capacity (VO2max) and exercise tolerance in congenital SFK patients without increasing the risks for cardiovascular accidents and accordingly sports activities should be strongly encouraged in SFK patients to maximize health benefits.
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Affiliation(s)
- Giancarlo Tancredi
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy.
| | - Caterina Lambiase
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
| | - Alessandra Favoriti
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
| | - Francesca Ricupito
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
| | - Sara Paoli
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
| | - Marzia Duse
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
| | - Giovanna De Castro
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
| | - Anna Maria Zicari
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
| | - Giovanna Vitaliti
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
| | - Raffaele Falsaperla
- General Pediatrics Operative Unit, Vittorio-Emanuele University Hospital, University of Catania, via S. Sofia, Catania, 78-95123, Italy
| | - Riccardo Lubrano
- Pediatric Department, "Sapienza" University of Rome, Viale Regina Margherita 324, Rome, 00161, Italy
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28
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Tabel Y, Aksoy Ö, Elmas AT, Çelik SF. Evaluation of hypertension by ambulatory blood pressure monitoring in children with solitary kidney. Blood Press 2015; 24:119-23. [PMID: 25580841 DOI: 10.3109/08037051.2014.992194] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this study, we aimed to investigate the blood pressure (BP) profile in children with a unilateral functioning solitary kidney (UFSK). A group of 49 patients between the ages of 5 and 18 years, and 30 healthy controls between the ages of 6 and 16 years were investigated. Gender, weight, height and body mass index (BMI) of patients and controls were recorded. BP profile was determined by ambulatory BP monitoring (ABPM). We have observed a higher risk of hypertension compared with healthy children. Also, masked hypertension is more frequently in the patients group and white-coat hypertension was observed in the control group. The mean night-time systolic BP (SBP) load (p = 0.01) and 24-h diastolic BP (DBP) load (p = 0.008) of children with multicystic dysplastic kidney (MCDK) was significantly higher than the healthy group. The mean night-time SBP load (p = 0.001) of children with unilateral renal agenesis (URA) and 24-h DBP load (p = 0.003) of children with unilateral atrophic or hypoplastic kidney were significantly higher than healthy group. We showed that the children with a solitary kidney had increased risk of hypertension. ABPM reflects the BP profile more precisely than casual BP measurement and it can be used to evaluate white-coat and masked hypertension in children with a solitary kidney.
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Affiliation(s)
- Yilmaz Tabel
- Department of Pediatric Nephrology, Faculty of Medicine, University of İnonu , Malatya , Turkey
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29
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Out-of-office blood pressure and target organ damage in children and adolescents. J Hypertens 2014; 32:2315-31; discussion 2331. [DOI: 10.1097/hjh.0000000000000384] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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30
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Ambulatory blood pressure monitoring is recommended in the clinical management of children with a solitary functioning kidney. Pediatr Nephrol 2014; 29:2205-11. [PMID: 24908323 DOI: 10.1007/s00467-014-2853-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Children with a solitary functioning kidney are at increased risk of developing chronic kidney disease. Hypertension may be an early indicator of renal dysfunction in these patients. We determined blood pressure (BP) profiles of children with a solitary functioning kidney by using ambulatory BP monitoring (ABPM). METHODS To assess the occurrence with (pre)hypertension, we compared ABPM to office BP measurement in 47 children with a solitary functioning kidney. None of the subjects used antihypertensive agents or had been hypertensive during previous clinical visits. RESULTS Mean age of study subjects was 12.7 (±3.3) years. Hypertension was identified in ten (21 %) subjects with ABPM, whereas only two (4 %) children were hypertensive during office BP measurement (p < 0.01). Fifteen (32 %) children had an ABPM standard deviation (SD) value ≥90th percentile versus six (13 %) subjects based on office BP measurement (p = 0.051). Although 24-h ABPM SD scores were higher in the congenital type than in the acquired type of solitary functioning kidney (p ≤ 0.01), the proportions of subjects with 24-h ABPM hypertension were similar between groups (congenital 25 % versus acquired 16 %; p = NS). CONCLUSIONS Based on ABPM, one in five children with a solitary functioning kidney has hypertension. As the majority of these subjects were not hypertensive during office BP measurements, ABPM should be considered in the clinical management of solitary functioning kidney patients.
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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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Shirzai A, Yildiz N, Biyikli N, Ustunsoy S, Benzer M, Alpay H. Is microalbuminuria a risk factor for hypertension in children with solitary kidney? Pediatr Nephrol 2014; 29:283-8. [PMID: 24217782 DOI: 10.1007/s00467-013-2641-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 06/03/2013] [Accepted: 06/17/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The correlations between ambulatory blood pressure measurements (ABPM) and serum cystatin C (Cys C), serum creatinine (Cr), microalbumin (MA), and β2-microglobulin (β2-MG) levels in 24 h (24-h) urine were analyzed in children with solitary kidney (SK) and compared to healthy children. METHODS Fifty children with normal functioning SK and 25 controls were studied. The ABPM, serum Cys C, serum Cr, MA, and β2-MG levels in 24-h urine were measured in all children. Clinical symptoms and signs, laboratory results, urinary ultrasonography, voiding cystourethrography, and Dimercaptosuccinic acid (DMSA) scintigraphy results were recorded in the SK group. Four patients with Wilms' tumor and two with renal scarring were excluded from the study. RESULTS The mean ages of the SK group and controls were 9.6 ± 3.6 and 9.3 ± 3.3 years, respectively. The serum Cys C and Cr levels, 24-h urinary β2-MG and MA levels were similar in both groups (p > 0.05). However, 24-h urinary MA excretion was higher in patients living with SK more than 5 years (p = 0.01). Standard deviation scores of ABPM parameters showed no significant correlation with serum Cr, serum Cys C, MA, and β2-MG in 24-h urine of both groups. CONCLUSIONS Children with SK have increased 24-h urinary MA excretion in the long term, and need prolonged follow-up to detect early deterioration of renal function and to prevent end-organ damage later in life.
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Affiliation(s)
- Ayoub Shirzai
- Department of Pediatric Nephrology, Marmara University Medical Faculty, Istanbul, Turkey
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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, Schreuder MF, Ket JCF, van Wijk JAE. Unilateral renal agenesis: a systematic review on associated anomalies and renal injury. Nephrol Dial Transplant 2013; 28:1844-55. [PMID: 23449343 DOI: 10.1093/ndt/gft012] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Unilateral renal agenesis (URA) is associated with other congenital anomalies of the kidney and urinary tract (CAKUT) and extra-renal anomalies. However, the reported prevalences of these anomalies are highly variable. We estimated the prevalence of associated CAKUT and extra-renal anomalies in patients with URA. Furthermore, we determined the prevalence of renal injury in URA patients. METHODS We conducted a systematic review of English and non-English articles using PubMed and Embase.com. Included studies reported at least one of the following items: incidence of URA, gender, side of URA, prenatal diagnosis, performance of micturating cystourethrogram, associated CAKUT, urinary tract infection or extra-renal anomalies. Studies that described a mean/median glomerular filtration rate (GFR) and proportions of patients with hypertension, micro-albuminuria or a decreased GFR were also included. RESULTS Analyses were based on 43 included studies (total number of patients: 2684, 63% male). The general incidence of URA was 1 in ∼2000. Associated CAKUT were identified in 32% of patients, of which vesicoureteral reflux was most frequently identified (24% of patients). Extra-renal anomalies were found in 31% of patients. Hypertension could be identified in 16% of patients, whereas 21% of patients had micro-albuminuria. Ten per cent of patients had a GFR<60 mL/min/1.73 m2;. CONCLUSIONS These aggregate results provide insight in the prevalence of associated anomalies and renal injury in patients with URA. Our systematic review implicates that URA is not a harmless malformation by definition. Therefore, we emphasize the need for clinical follow-up in URA patients starting at birth.
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Affiliation(s)
- Rik Westland
- Department of Pediatric Nephrology, VU University 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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Seeman T, Pohl M, Palyzova D, John U. Microalbuminuria in children with primary and white-coat hypertension. Pediatr Nephrol 2012; 27:461-7. [PMID: 21971642 DOI: 10.1007/s00467-011-2019-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 08/02/2011] [Accepted: 08/04/2011] [Indexed: 12/18/2022]
Abstract
Microalbuminuria serves as an early marker of hypertension-related renal damage in adults. However, data on the prevalence of microalbuminuria in paediatric hypertensive patients in general and in children with white-coat hypertension (WCH) specifically are lacking. The aim of our study was to investigate the prevalence of microalbuminuria in children with primary hypertension (PH) and WCH, respectively. This was a retrospective case review of children with PH and WCH treated at three paediatric nephrology centres. Untreated children with either form of hypertension for whom measurements of urinary albumin excretion (UAE) had been performed were enrolled in the study. The study cohort comprised 52 children (39 boys) with hypertension (26 children with PH, 26 with WCH). Microalbuminuria (>3.2 mg/mmol creatinine) was present in 20% of children with PH and none of the children with WCH (p < 0.01). Children with PH had a higher median UAE than those with WCH (1.27 ± 1.92 vs. 0.66 ± 0.46 mg/mmol creatinine, p < 0.05). Based on these results, we suggest that children with PH have an increased prevalence of microalbuminuria, while children with WCH show no signs of hypertension-related renal damage.
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Affiliation(s)
- Tomáš Seeman
- Department of Paediatrics, University Hospital Motol, 2nd School of Medicine, Charles University Prague, V Uvalu 84, 15006, Prague 5, Czech Republic.
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Stefanowicz J, Owczuk R, Kałużyńska B, Aleksandrowicz E, Owczarzak A, Adamkiewicz-Drożyńska E, Balcerska A. Renal function and solitary kidney disease: Wilms tumour survivors versus patients with unilateral renal agenesis. Kidney Blood Press Res 2011; 35:174-81. [PMID: 22116374 DOI: 10.1159/000332083] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 08/21/2011] [Indexed: 11/19/2022] Open
Abstract
AIMS To test the hypothesis that Wilms tumour survivors (WTs) experience increased disturbance in renal function, even after prompt treatment, compared to patients with unilateral renal agenesis (URA). METHODS To assess the renal function of 30 WTs and 17 individuals with URA, the estimated glomerular filtration rate (eGFR) was calculated using the Schwartz and Filler formulas as well as the new Schwartz equation for chronic kidney disease. To measure kidney damage, serum levels and urine excretion of β(2)-microglobulin (B2M), cystatin C (Cys C), neutrophil gelatinase-associated lipocalin (NGAL) were tested, N-acetyl-β-glucosaminidase (NAG), and albumin urine excretion and urine sediment were examined. Blood pressure was measured. RESULTS No differences were found between the groups in terms of eGFR, serum Cys C, B2M and NGAL concentrations. The urine excretion of Cys C, NGAL and NAG was similar in both groups. URA patients had higher B2M excretion than WTs. Arterial hypertension was present in 7/30 (23%) WTs and 1/17 (6%) patients with URA. CONCLUSIONS WTs have similar eGFR to individuals with URA and are more likely to have arterial hypertension. The patients with URA have signs of tubular damage. This study demonstrates the need for nephrological monitoring of individuals with a single kidney.
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Affiliation(s)
- Joanna Stefanowicz
- Department of Paediatrics, Haematology, Oncology and Endocrinology, Medical University of Gdansk, Gdansk, Poland
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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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Abou Jaoudé P, Dubourg L, Bacchetta J, Berthiller J, Ranchin B, Cochat P. Congenital versus acquired solitary kidney: is the difference relevant? Nephrol Dial Transplant 2010; 26:2188-94. [PMID: 21045075 DOI: 10.1093/ndt/gfq659] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Serious concerns have risen during the last decades regarding the potential role of solitary kidney (SK) in promoting systemic hypertension, proteinuria and glomerulosclerosis. The aim of the study was to assess mid- and long-term outcome of children with SK, with special highlight on the differential functional outcome of congenital and acquired forms of SK. METHODS Ninety-seven patients (43 females) aged from 2.9 to 25 years with radiologically normal SK were divided into two groups depending on whether they had a congenital (CSK, n = 44) or an acquired SK (ASK, n = 53). Mean follow-up time with SK was 8.3 ± 3.2 and 9.1 ± 4.4 years, respectively (P = NS). Blood pressure (BP), glomerular filtration rate (GFR) measured by inulin clearance, and microalbuminuria were assessed in all patients. RESULTS Two children (2%), one in each group, had systemic hypertension confirmed by 24-h ambulatory BP monitoring, and 17 (17.5%) had a significant microalbuminuria (8 in CSK and 9 in ASK, P = NS). The overall mean GFR was 100.6 ± 15 mL/min/1.73 m(2) and was found to be inversely correlated with age and follow-up time. Seven children had a GFR <80 mL/min/1.73 m(2), all had been nephrectomized in early childhood. Interestingly, GFR was higher in CSK than in ASK group (107.2 vs. 95.2 mL/min/1.73 m(2), P < 0.01) and was negatively related to follow-up time only in the latter but not in the former group. CONCLUSIONS In the light of these results, it appears that renal function in children with SK is well preserved in short and medium term, but it seems to decline gradually with longer periods of follow-up, particularly in ASK, thus assuming a better functional adaptation in CSK. Both conditions remain yet risky and predispose children to a greater incidence of hypertension and renal impairment in later life. Thereby, careful screening should be proposed throughout childhood to detect early signs of glomerular hyperfiltration and prevent its progression to more serious complications.
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Affiliation(s)
- Pauline Abou Jaoudé
- Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant Université de Lyon, Lyon, France.
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Ruta LAM, Dickinson H, Thomas MC, Denton KM, Anderson WP, Kett MM. High-salt diet reveals the hypertensive and renal effects of reduced nephron endowment. Am J Physiol Renal Physiol 2010; 298:F1384-92. [PMID: 20335316 DOI: 10.1152/ajprenal.00049.2010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The extent to which a reduced nephron endowment contributes to hypertension and renal disease is confounded in models created by intrauterine insults that also demonstrate other phenotypes. Furthermore, recent data suggest that a reduced nephron endowment provides the "first hit" and simply increases the susceptibility to injurious stimuli. Thus we examined nephron number, glomerular volume, conscious mean arterial pressure (MAP), and renal function in a genetic model of reduced nephron endowment before and after a high-salt (5%) diet. One-yr-old glial cell line-derived neurotrophic factor wild-type (WT) mice, heterozygous (HET) mice born with two kidneys (HET2K), and HET mice born with one kidney (HET1K) were used. Nephron number was 25% lower in HET2K and 65% lower in HET1K than WT mice. Glomeruli hypertrophied in both HET groups by 33%, resulting in total glomerular volumes that were similar between HET2K and WT mice but remained 50% lower in HET1K mice. On a normal-salt diet, 24-h MAP was not different between WT, HET2K, and HET1K mice (102 +/- 1, 103 +/- 1, and 102 +/- 2 mmHg). On a high-salt diet, MAP increased 9.1 +/- 1.9 mmHg in HET1K mice (P < 0.05) and 5.4 +/- 0.9 mmHg in HET2K mice (P < 0.05) and did not change significantly in WT mice. Creatinine clearance was 60% higher in WT mice but 30% lower in HET2K and HET1K mice fed a high-salt diet than in controls maintained on a normal-salt diet. Thus a reduction in nephron number (or total glomerular volume) alone does not lead to hypertension or kidney disease in aged mice, but exposure to high salt uncovers a hypertensive and renal phenotype.
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Affiliation(s)
- Leah-Anne M Ruta
- Department of Physiology, Monash University, Clayton, Victoria, Australia
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Reduced nephron endowment due to fetal uninephrectomy impairs renal sodium handling in male sheep. Clin Sci (Lond) 2010; 118:669-80. [PMID: 20067444 DOI: 10.1042/cs20090479] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Reduced nephron endowment is associated with development of renal and cardiovascular disease. We hypothesized this may be attributable to impaired sodium homoeostasis by the remaining nephrons. The present study investigated whether a nephron deficit, induced by fetal uninephrectomy at 100 days gestation (term=150 days), resulted in (i) altered renal sodium handling both under basal conditions and in response to an acute 0.9% saline load (50 ml.kg-1 of body weight.30 min-1); (ii) hypertension and (iii) altered expression of renal channels/transporters in male sheep at 6 months of age. Uninephrectomized animals had significantly elevated arterial pressure (90.1+/-1.6 compared with 77.8+/-2.9 mmHg; P<0.001), while glomerular filtration rate and renal blood flow (per g of kidney weight) were 30% lower than that of the sham animals. Total kidney weight was similar between the groups. Renal gene expression of apical NHE3 (type 3 Na+/H+ exchanger), ENaC (epithelium Na+ channel) beta and gamma subunits and basolateral Na+/K+ ATPase beta and gamma subunits were significantly elevated in uninephrectomized animals, while ENaC alpha subunit expression was reduced. Urine flow rate and sodium excretion increased in both groups in response to salt loading, but this increase in sodium excretion was delayed by approximately 90 min in the uninephrectomized animals, while total sodium output was 12% in excess of the infused load (P<0.05). In conclusion, the present study shows that animals with a congenital nephron deficit have alterations in tubular sodium channels/transporters and cannot rapidly correct for variations in sodium intake probably contributing to the development of hypertension. This suggests that people born with a nephron deficit should be monitored for early signs of renal and cardiovascular disease.
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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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Poster D, Kistler AD, Krauer F, Blumenfeld JD, Rennert H, Weishaupt D, Wüthrich RP, Serra AL. Kidney Function and Volume Progression in Unilateral Autosomal Dominant Polycystic Kidney Disease With Contralateral Renal Agenesis or Hypoplasia: A Case Series. Am J Kidney Dis 2009; 54:450-8. [PMID: 19515475 DOI: 10.1053/j.ajkd.2009.03.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Accepted: 03/11/2009] [Indexed: 11/11/2022]
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Development of cardiovascular disease due to renal insufficiency in male sheep following fetal unilateral nephrectomy. J Hypertens 2009; 27:386-96. [PMID: 19155792 DOI: 10.1097/hjh.0b013e32831bc778] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Renal insufficiency is associated with the development of cardiovascular disease. OBJECTIVES This study investigated whether reduced fetal renal mass resulted in renal insufficiency, hypertension, cardiac dysfunction and whether these changes progressed with age. METHODS AND RESULTS Fetal uninephrectomy was performed at 100-day gestation (term, 150 days) and studies performed in male sheep from 6 weeks to 24 months of age. Renal function declined with age in sham animals as demonstrated by increasing plasma creatinine levels and urinary excretion of albumin. The age-related decline in renal function was exacerbated in animals that had undergone fetal uninephrectomy. Evidence of renal insufficiency was indicated from as early as 6 weeks of age with elevations in plasma creatinine (Ptreatment < 0.001), urea (Ptreatment < 0.001) and sodium (Ptreatment < 0.05) levels in uninephrectomized lambs as compared with sham animals. At 6 months, urinary albumin excretion (P < 0.001) was increased and urinary sodium excretion (P < 0.001) decreased in the uninephrectomized animals. By 24 months, renal function had deteriorated further with significant progression of albuminuria (P(treatment x age) < 0.001). Elevation of mean arterial pressure (approximately 15 mmHg) was associated with significantly increased cardiac output, stroke volume and plasma volume at 6 months; arterial pressure (approximately 27 mmHg) had increased further in uninephrectomized animals at 24 months and was driven by increased total peripheral resistance. Cardiac functional reserve (dobutamine challenge) was reduced in uninephrectomized animals at 6 and 24 months of age (Ptreatment < 0.001), and this was associated with left ventricular enlargement (P < 0.001) and reduced fractional shortening (P < 0.01). CONCLUSION Fetal uninephrectomy causing a reduction in nephron endowment results in an accelerated age-related decline in renal function. This is associated with an early onset of elevated blood pressure and impairments in cardiac structure and function.
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Shweta A, Cullen-McEwen LA, Kett MM, Evans RG, Denton KM, Fitzgerald SM, Anderson WP, Bertram JF. Glomerular surface area is normalized in mice born with a nephron deficit: no role for AT1receptors. Am J Physiol Renal Physiol 2009; 296:F583-9. [DOI: 10.1152/ajprenal.90359.2008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We examined whether deficits in glomerular capillary surface area associated with a congenital nephron deficit could be corrected by glomerular hypertrophy. Using unbiased stereological techniques, we examined the time course and mode of glomerular hypertrophy in mice lacking one allele for glial cell line-derived neurotrophic factor (GDNF). These GDNF heterozygous (Het) mice are born with ∼30% less nephrons than wild-type (WT) littermates. An additional group of GDNF Het mice received the angiotensin type 1 (AT1)-receptor antagonist candesartan (Cand; 10 mg·kg−1·day−1) from 5 wk of age to determine the role of AT1receptors in the compensatory hypertrophy. At 10 wk of age, the total volume of renal corpuscles, glomerular capillary surface area, and length of glomerular capillaries in the kidneys of GDNF Het mice were all markedly (∼45%) less than that of WT mice ( P < 0.001). However, by 30 wk, and persisting at 60 wk of age, GDNF Het and WT mice did not significantly differ in any of these parameters. Furthermore, conscious 24-h mean arterial pressure (MAP) did not differ between GDNF Het and WT mice at any time point. MAP of GDNF Het-Cand mice was 20–30 mmHg less than that of GDNF Het-vehicle mice at all three ages, but Cand treatment did not significantly alter glomerular capillary dimensions. In conclusion, we have demonstrated that the deficit in glomerular capillary surface area associated with a congenital nephron deficit can be corrected for in adulthood by an increase in the total length of glomerular capillaries. This process does not require AT1receptor activation.
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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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Vu KH, Van Dyck M, Daniels H, Proesmans W. Renal outcome of children with one functioning kidney from birth. A study of 99 patients and a review of the literature. Eur J Pediatr 2008; 167:885-90. [PMID: 17940797 DOI: 10.1007/s00431-007-0612-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 09/10/2007] [Accepted: 09/12/2007] [Indexed: 11/29/2022]
Abstract
In patients with a single functioning kidney, renal function was assessed at regular intervals over a period of 10 years. Serum creatinine, glomerular filtration rate (GFR), blood pressure, and urinary protein-creatinine ratio were assessed at the age of 2, 5 and 10 years. Between January 1980 and December 2005, 99 such patients were diagnosed in the first year of life. They were divided into three groups: A, patients with multicystic kidney disease and a normal contralateral kidney (n = 36); B, patients with a normal solitary kidney without uropathy (n = 20); and C, patients with obstructive uropathy and one nonfunctioning kidney (n = 43). Serum creatinine levels increased significantly with increasing age in every group. In group C, serum creatinine was significantly elevated compared with group A in all age categories (p = 0.043, p = 0.019, p = 0.001 respectively). Median figures of GFR remained within normal limits over the 10-year period. GFR was significantly lower in group C compared with group A (p = 0.001, p = 0.009, p = 0.019 respectively) and B in all age categories (p = 0.013, p = 0.002, p = 0.016 respectively). There were no changes in blood pressure over time and no differences among the three groups were observed. At the age of 10 years, the patients in group C had a significantly higher median urinary protein-creatinine ratio (p = 0.022) than those in groups A and B. There was also an increasing level of proteinuria with increasing age in group C (p = 0.002). In conclusion, renal function was stable over time in all patients, but children with obstructive uropathy have a lower median GFR and higher serum creatinine level for the whole study period. Hypertension was exceptionally observed in group C, with obstructive uropathy, as was an elevated urinary protein-creatinine ratio.
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Affiliation(s)
- Kieu-Hanh Vu
- Pediatric Nephrology, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
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Moritz KM, Singh RR, Probyn ME, Denton KM. Developmental programming of a reduced nephron endowment: more than just a baby's birth weight. Am J Physiol Renal Physiol 2008; 296:F1-9. [PMID: 18653482 DOI: 10.1152/ajprenal.00049.2008] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The risk of developing many adult-onset diseases, including hypertension, type 2 diabetes, and renal disease, is increased in low-birth-weight individuals. A potential underlying mechanism contributing to the onset of these diseases is the formation of a low nephron endowment during development. Evidence from the human, as well as many experimental animal models, has shown a strong association between low birth weight and a reduced nephron endowment. However, other animal models, particularly those in which the mother is exposed to elevated glucocorticoids for a short period, have shown a 20-40% reduction in nephron endowment without discernible changes in the birth weight of offspring. Such findings emphasize that a low birth weight is one, but certainly not the only, predictor of nephron endowment and suggests reduced nephron endowment and risk of developing adult-onset disease, even among normal-birth-weight individuals. Recognition of the dissociation between birth weight and nephron endowment is important for future studies aimed at elucidating the role of a reduced nephron endowment in the developmental programming of adult disease.
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Affiliation(s)
- Karen M Moritz
- School of Biomedical Sciences, Univ. of Queensland, 4072, Australia.
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50
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Schreuder MF, Langemeijer ME, Bökenkamp A, Delemarre-Van de Waal HA, Van Wijk JAE. Hypertension and microalbuminuria in children with congenital solitary kidneys. J Paediatr Child Health 2008; 44:363-8. [PMID: 18476930 DOI: 10.1111/j.1440-1754.2008.01315.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM According to the hyperfiltration hypothesis, a low nephron endowment will lead to hyperfiltration in the remaining glomeruli and is associated with systemic hypertension, proteinuria and glomerulosclerosis. Being born with one functioning kidney instead of two, for instance because of unilateral renal agenesis or multicystic dysplastic kidney, is a cause of congenital renal mass reduction. METHODS In order to study the effect of congenital renal mass reduction on renal function and blood pressure, a retrospective chart review of 66 patients at the Pediatric Renal Center of the VU University Medical Center was performed. As intrauterine growth restriction is associated with a low nephron endowment, the additional effect of birthweight was also studied. RESULTS A total of 50% of patients with congenital renal mass reduction is found to be hypertensive, using anti-hypertensive drugs, and/or having microalbuminuria (>20 mug/min). Patients born small for gestational age have significantly smaller kidneys and lower estimated glomerular filtration rate than patients with a normal birthweight. CONCLUSIONS We conclude that microalbuminuria and/or hypertension is present in 50% of patients with congenital solitary kidneys, which warrants a systematic follow-up of blood pressure, proteinuria and renal function in all patients with congenital solitary functioning kidneys, especially in patients with a low birthweight.
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Affiliation(s)
- Michiel F Schreuder
- Department of Pediatric Nephrology, VU University Medical Center, Amsterdam, The Netherlands.
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