Solitary functioning kidney in children: clinical implications

Radhakrishna, Veerabhadra; Govindarajan, Krishna Kumar; Kumaravel, S; Jindal, Bibekanand; Naredi, BikashKumar

doi:10.1590/1678-4685-jbn-3942

Cited by 8 publications

(5 citation statements)

References 13 publications

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“…Renal injury developed in 9% of our patients (2.8% of the CSK group and 23.3% of the ASK group, p = 0.001). Our study showed that ASK significantly increased the prevalence of renal injury when compared with CSK, which is in agreement with the results reported by Abou Jaoude et al 17 and Radhakrishna et al 18 This may be due to the potential to form new nephrons in CSK whereas ASK probably loses its nephrogenesis capability until nephrectomy is performed. 7,8,17,18 In similar studies, the incidence of HT was variable, ranging from 0% to 50%.…”

Section: Discussionsupporting

confidence: 93%

“…Our study showed that ASK significantly increased the prevalence of renal injury when compared with CSK, which is in agreement with the results reported by Abou Jaoude et al 17 and Radhakrishna et al 18 This may be due to the potential to form new nephrons in CSK whereas ASK probably loses its nephrogenesis capability until nephrectomy is performed. 7,8,17,18 In similar studies, the incidence of HT was variable, ranging from 0% to 50%. 17 Among SK cases, HT was detected at a rate of 13% by Westland et al 6 26% by Dursun et al 19 and 2% by Abou Jaoude et al 17 In our patients with SK, the prevalence of HT was 3%, and all of these patients had ASK.…”

Section: Discussionsupporting

confidence: 93%

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Follow up of renal outcomes in children with solitary kidney

Önder

Yılmaz

Taneli

et al. 2023

Pediatrics International

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BackgroundSolitary kidney (SK) affects 1/1000 people worldwide, and there are controversies concerning renal outcomes in these patients. This study aimed to investigate clinical findings and renal outcomes in children with SK and to compare the results for congenital (CSK) and acquired SK (ASK) groups.MethodsThe study included patients that presented to our pediatric nephrology department with SK between January 2010 and January 2021. Demographic and clinical data were recorded retrospectively.ResultsOf the 101 patients with SK, 71 had CSK (55 had unilateral renal agenesis and 16 had a multicystic dysplastic kidney) and 30 had ASK (17 had previously undergone unilateral nephrectomy due to a renal tumor and 13 had urological structural anomalies). There were nine patients (9%) with renal injury. The serum uric acid level was significantly higher and the estimated glomerular filtration rate was significantly lower in the patients with ASK compared with those with CSK (p = 0.005 and p < 0.001, respectively). There was a positive correlation between renal injury and the uric acid level (p < 0.001, r = 0.45).ConclusionIn addition to the management of blood pressure and proteinuria, it is important to control uric acid levels in patients with SK, especially those with ASK, to prevent renal injury. The ASK group has a greater risk of renal injury than the CSK group. There is a need for new markers to predict early stage renal damage in SK.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Follow up of renal outcomes in children with solitary kidney

Önder

Yılmaz

Taneli

et al. 2023

Pediatrics International

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“…Hypertension was noted in 13% of cases by Westland et al [ 1 ], 17% by Schreuder [ 17 ], and 26% by Dursun et al [ 12 ]. In Radhakrishna et al [ 18 ] study 91% of their study group had at least one of the markers of renal injury such as albuminuria, reduced eGFR, or hypertension. We also found that the major part of the study group had features of kidney damage (65% of the study population), which is more than found in other studies such as by Sanna-Cherchi et al [ 19 ] (29.5%) and Akl (20%) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Tumor Necrosis Factor-Like Weak Inducer of Apoptosis and Selected Cytokines—Potential Biomarkers in Children with Solitary Functioning Kidney

Nosek

Jankowska

Brzozowska

et al. 2021

JCM

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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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“…conference presentations), while 227 were excluded after reading the full text because they did not fulfil the inclusion criteria. At this stage, 65 studies were selected for data extraction, during which four additional studies [ 16–19 ] had to be excluded because of an insufficient number of patients with nephrectomy from whom data were available, four studies [ 20–23 ] were excluded because of insufficient reporting of outcomes and seven studies [ 24–30 ] were removed because a more recent article about the same cohort was available. This resulted in 50 articles for the initial analyses.…”

Section: Resultsmentioning

confidence: 99%

Kidney injury rates after unilateral nephrectomy in childhood—a systematic review and meta-analysis

Woud

Gobino

Roeleveld³

et al. 2022

Nephrology Dialysis Transplantation

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Background Unilateral nephrectomy is a relatively common procedure in children which results in a solitary functioning kidney (SFK). Living with an SFK predisposes to kidney injury, but it remains unknown which children are most at risk. We aimed to investigate kidney injury rates in patients who underwent unilateral nephrectomy in childhood and to investigate differences among nephrectomies performed for a congenital anomaly, malignancy, or other condition. Methods MEDLINE and EMBASE were searched for studies reporting kidney injury rates (i.e. proteinuria, hypertension, and/or a decreased GFR) of patients who underwent unilateral nephrectomy during childhood. Studies including five or more patients with at least 12 months of follow-up were eligible. Analyses were performed using random effects models and stratified by indication for nephrectomy. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and meta-analysis of observational studies in epidemiology (MOOSE) guidelines were used for reporting. Results Over 5000 unique articles were screened, of which 53 studies reporting on > 4000 patients were included in the analyses. Proteinuria, hypertension and a decreased GFR were present in 15.3%, 14.5%, and 11.9% of patients, respectively. Heterogeneity among the studies was large in several subgroups, impairing quantitative meta-analyses. However, none of our analyses indicated differences in injury rates between a congenital anomaly or malignancy as indication for nephrectomy. Conclusions Unilateral nephrectomy during childhood results in signs of kidney injury in > 10% of patients, with no clear difference between the indications for nephrectomy. Therefore, structured follow-up is necessary in all children who underwent nephrectomy, regardless of the indication.

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Solitary functioning kidney in children: clinical implications

Abstract: Children with SFK have high morbidity especially when associated with ipsilateral CAKUT. Long-term periodical follow up is essential in these patients to improve clinical outcome.

Cited by 8 publications

References 13 publications

Follow up of renal outcomes in children with solitary kidney

Follow up of renal outcomes in children with solitary kidney

Tumor Necrosis Factor-Like Weak Inducer of Apoptosis and Selected Cytokines—Potential Biomarkers in Children with Solitary Functioning Kidney

Kidney injury rates after unilateral nephrectomy in childhood—a systematic review and meta-analysis

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