Canadian Urological Association Best Practice Report: Sports and the solitary kidney - What primary caregivers of a young child with a single kidney should know (2019 update)

Airbag Vests in Equestrian Sports: Is Use Associated with Harm?

Airbag vests (AV) are increasingly popular in equestrian sports. The efficacy of AV in protecting against serious injury has not been adequately analyzed, nor have product testing standards been established. This study provides an overview of current research to understand AV efficacy and future areas of improvement. A systematic review applying the PRISMA framework, NIH Study Quality Assessment, and CEBM Level of Evidence was conducted. Employing variations of "equestrian sport," "powered two-wheeled vehicle," "thoracic injury," "chest deflection," "airbag vest," and "safety vest," 18 articles were identified for data collection from three recognized research databases and citation searching. In laboratory settings, the ability of AV to protect against thoracic injuries was variable based on concurrent foam-based safety vest (SV) usage, impact speed, and impact mechanism. Studies that examined equestrian falls with AV found an association with increased injury rates and risk. SVs were shown to provide inconclusive efficacy in protecting against injuries in experimental and cohort studies. Protective capabilities depend on material, temperature, and impact mechanism. Further limiting use, equestrians reported not wearing, or incorrectly wearing SV due to unknown benefits, low comfort, and ill fit. In equestrian sports, based on published literature to date, AV have not been associated with a reduction in injury. AV appear to be associated with an increase in the risk of serious or fatal injuries in certain settings. However, research in this area is limited and future, large-scale studies should be conducted to further evaluate the efficacy of the air vests.

A Narrative Review of Contact Sports Participation in Children and Young Athletes With a Solitary (Functioning) Kidney

BACKGROUND

Evidence is sparse regarding the incidence or prevalence of renal or genitourinary injuries arising from contact sports. There are currently no World Health Organization or European consensus guidelines relating to the participation in sport for children and young athletes with a solitary (functioning) kidney.

PURPOSE

To review the international literature and to make sport-specific recommendations for children and young athletes with a solitary (functioning) kidney participating in sports, based on the overall likelihood of potential renal or genitourinary injury.

STUDY DESIGN

Narrative review; Level of evidence, 4.

METHODS

A descriptive epidemiological study was conducted of current literature according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Embase, Google Scholar, Cochrane, and PubMed databases were queried from 1975 to 2023, to assess available evidence regarding the prevalence and risk of renal injury through sports participation and guidelines surrounding the participation in sports for children and young athletes with a solitary (functioning) kidney. Methodological quality and certainty of evidence were assessed according to the International Classification of Urological Disease guidelines.

RESULTS

A total of 28 publications were identified after database searches and exclusions, comprising 40,889 patients. The majority of papers providing recommendations arose from the United States. Of the recommendations, 79% permitted an unrestricted return to noncontact sports. A return to contact sports is permitted in most instances after physician consultation.

CONCLUSION

There is a dearth of good-quality published evidence in the literature relating to sports participation with a solitary (functioning) kidney. Overall, the risk of genitourinary injury in sports is low, and after physician assessment, there is currently no strong evidence to exclude children and young athletes with a solitary (functioning) kidney from full participation in contact and collision sports.

Antenatally Diagnosed Kidney Anomalies

Congenital anomalies of the kidney and urinary tract encompass a broad spectrum of developmental conditions that together account for the majority of childhood chronic kidney diseases. Kidney abnormalities are the most commonly diagnosed congenital anomaly in children, and detection of this anomaly is increasing as a result of improved antenatal care and widespread access to more sensitive screening ultrasonography. Most paediatricians will encounter children with congenital kidney anomalies across a wide spectrum of disorders, and a broad understanding of the classification, investigation, and basis of management is important to appropriately direct their care.

Management of the congenital solitary kidney: consensus recommendations of the Italian Society of Pediatric Nephrology

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.