Ambulatory blood pressure monitoring in children with a solitary kidney – a comparison between unilateral renal agenesis and uninephrectomy

Abstract

Compared with the age-, height- and weight-matched controls, the children with a solitary kidney caused by URA had an elevated mean 24 h SBP. In contrast, those with UNX had mean 24 h blood pressure values similar to those of their controls. A rise in SBP was, however, seen in both groups during the daytime hours. Thus, the presence of a solitary kidney, for whatever reason, may be pathogenetically linked to a raised blood pressure, and this linkage may be more pronounced in URA. The delta increase in size of the remaining kidney may serve as a prognostic indicator of blood pressure elevation.

Ultradian but not Circadian Blood Pressure Rhythms Correlate with Renal Dysfunction in Children with Chronic Renal Failure

“…Studies that have used conventional dipping analyses in children with intact renal function have revealed blunted dipping in patients with renal scars secondary to reflux or recurrent urinary tract infection (24) but not in a cohort with solitary kidneys (25). That conventional dipping analyses in children report less consistent findings is in line with our description of only moderate agreement between the conventional dipping status and the presence of a circadian amplitude.…”

Nephron Number, Hypertension, Renal Disease, and Renal Failure

“…In humans, loss of substantial kidney mass (accidents, resections, cancers, obstructions, vascular occlusions, cortical necrosis, etc.) can have similar results, whereas transplantation of small kidney donor organs into large recipients increases the risk for hypertension and graft failure (36,37).…”

“…Proliferation of nephrons is particularly rapid in the last trimester, continuing up through the 36th week, then it ceases (32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44). The final complement of nephrons, which is reflected in kidney volume estimates by ultrasound, as well as in kidney mass and nephron number, is critically dependent on two factors: gestational age and a favorable intrauterine environment.…”

Developmental programming of a reduced nephron endowment: more than just a baby's birth weight

“…In human patients with unilateral renal agenesis, in whom nephron endowment is reduced from birth, the incidence of renal insufficiency and proteinuria is common (2,61), and, in many cases, infants with one kidney also have contralateral renal abnormalities (18,35,62), the most common of which may further contribute to renal problems. Children with unilateral renal agenesis often develop elevated arterial pressure (73,95), although it is difficult to know whether this is directly due to a reduced nephron endowment.…”