Congenital versus acquired solitary kidney: is the difference relevant?

Jaoudé, Pauline Abou; Dubourg, Laurence; Bacchetta, Justine; Berthiller, Julien; Ranchin, Bruno; Cochat, Pierre

doi:10.1093/ndt/gfq659

Cited by 68 publications

(58 citation statements)

References 56 publications

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“…We identified renal injury in both the congenital and acquired SFK group. In contrast, Jaoude et al found a significant difference favoring congenital SFK, which they interpreted as indicating a better functional adaptation in that etiological category [17]. Furthermore, a significant influence of CAKUT on renal injury prognosis was found even in our small sample in line with Westland's et al findings.…”

Section: Discussionsupporting

confidence: 72%

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Solitary Functioning Kidney in Children - A Follow-Up Study

Kolvek

Podracká

Rosenberger

et al. 2014

Kidney Blood Press Res

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Background/Aims: This study aims to assess the cumulative incidence of elevated albuminuria, hypertension and decreased estimated glomerular filtration rate (eGFR) to identify possible renal injury in children with SFK. Methods: Forty-two children with SFK (23 boys; 27 congenital) were included in a prospective follow-up study. Blood pressure, albuminuria and eGFR were assessed repeatedly and the cumulative incidence rate of various forms of renal injury, overall and by type of etiology, were evaluated. Finally, renal injury-free survival was analyzed. Results: Mean follow-up was until age 11.3 years (SD 6.3 years). During follow-up, 16 (38.1%) patients met the criteria for renal injury, defined as hypertension (10; 23.8%), severely increased albuminuria (3; 7.1%) and a significantly impaired eGFR (<60ml/min/1.73m²) (5; 11.9%) and/or use of antihypertensive or antiproteinuric medication (11; 26.2%). Children with CAKUT in SFK had a significantly higher incidence of renal injury. The median time to develop renal injury was 12.8 years. Conclusion: A substantial proportion of children with SFK develop renal injury during childhood, especially those with CAKUT in the SFK. Therefore, close follow-up of albuminuria, blood pressure and eGFR are warranted to identify chronic kidney disease in its early stages.

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Section: Discussionsupporting

confidence: 72%

“…In children with SFK controversies regarding renal function exist. Some studies support favorable outcomes, which is the opposite of what might be expected according to the Brenner hypothesis [15,16], while others do not, both in children after nephrectomy [17,18] and in children with congenital SFK [19]. Follow-up studies are scarce.…”

Section: Introductionmentioning

confidence: 99%

Solitary Functioning Kidney in Children - A Follow-Up Study

Kolvek

Podracká

Rosenberger

et al. 2014

Kidney Blood Press Res

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“…In support of our hypothesis, a study of congenital solitary kidney at older age (average 39 years) also reported a higher percentage of renal injury (proteinuria 19%, hypertension 47%, and renal dysfunction 13%) [22]. Inverse relationship between age and renal injury was also reported in subjects with a solitary kidney [23]. …”

Section: Discussionsupporting

confidence: 70%

Trajectory of Estimated Glomerular Filtration Rate Predicts Renal Injury in Children with Multicystic Dysplastic Kidney

Matsumura¹,

Sugii²,

Awazu³

2018

Nephron

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Background/Aims: Children with a solitary functioning kidney have a risk of renal injury caused by hyperfiltration. Timely intervention with renin-angiotensin inhibitors may be beneficial. We examined whether trajectory of estimated glomerular filtration rate (eGFR) would predict renal injury, defined as microalbuminuria/proteinuria, hypertension, and/or a decline in eGFR. Methods: Seventeen patients (male 7, female 10) with multicystic dysplastic kidney (MCDK; median age 13 years, range 6–19 years) followed in our clinic were examined retrospectively. An eGFR decline was defined as a fall to < 90 mL/min/1.73 m² or a decline of > 5 mL/min/1.73 m²/year for those with baseline eGFR of ≥90 or < 90 mL/min/1.73 m² respectively. Results: Nine patients had renal injury at the time of investigation. Compared with 8 patients without renal injury, those with renal injury tended to be older (14.7 ± 4.2 vs. 11.4 ± 4.6 years) and the birth weight was smaller (2,538 ± 281 vs. 2,966 ± 361 g, p < 0.05). The frequency of contralateral congenital anomaly of kidney and urinary tract (cyst, hydronephrosis, or vesicoureteral reflux) were not different. The trajectory of eGFR in those without renal injury was either an increase (n = 3) or unidentifiable (n = 5), whereas that in the renal injury group was exclusively an increase followed by decline (p < 0.05). The average age of the onset of eGFR decline was 9.4 ± 4.2 years and that of the start of renal injury (albuminuria/proteinuria 5, eGFR decline 4, hypertension 1) was 12.5 ± 4.2 years. Conclusion: All the children with MCDK who developed renal injury had eGFR trajectory of increase followed by decline. Renal injury followed the peak eGFR by 3 years on average. This observation is in agreement with the hyperfiltration theory and underscores the importance of following eGFR trajectory closely.

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“…This finding may imply a higher susceptibility for pronounced glomerular hyperfiltration in acquired solitary functioning kidney patients. Abou Jaoudé et al (35) reported a lower GFR in children with an acquired solitary functioning kidney than children with a congenital solitary functioning kidney (mean GFR: 95 versus 107 ml/min per 1.73 m 2 , respectively). Nevertheless, differences between types are generally small and may also be explained by the older age in children with an acquired solitary functioning kidney (13).…”

Section: Clinical Outcomementioning

confidence: 97%

Clinical Implications of the Solitary Functioning Kidney

Westland

Schreuder

Goudoever

et al. 2014

Clinical Journal of the American Society of Nephrology

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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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Congenital versus acquired solitary kidney: is the difference relevant?

Cited by 68 publications

References 56 publications

Solitary Functioning Kidney in Children - A Follow-Up Study

Solitary Functioning Kidney in Children - A Follow-Up Study

Trajectory of Estimated Glomerular Filtration Rate Predicts Renal Injury in Children with Multicystic Dysplastic Kidney

Clinical Implications of the Solitary Functioning Kidney

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