Cardiovascular risk assessment in children and adolescents with congenital solitary kidneys

Abstract

It is well known that patients with solitary kidneys (SKs) are at risk of hypertension (HT), proteinuria, and glomerulosclerosis due to their low number of nephrons. 1-4 They tend to have higher levels of HT-associated end-organ damage markers, such as left ventricular mass index (LVMI) and microalbuminuria. 5 Congenital SKs (CSKs) or acquired SKs (ASKs) have different effects on glomerular filtration rate (GFR) and blood pressure (BP).

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

“…Ten studies evaluated BP by ABPM in a total number of 379 children with CSK [ 28 , 32 , 37 , 70 – 75 , 85 ] (Table 7 ). Five studies reported data on kidney length for a total of 136 patients and about 86% presented compensatory enlargement [ 28 , 32 , 70 , 72 , 85 ].…”

“…Five studies reported data on kidney length for a total of 136 patients and about 86% presented compensatory enlargement [ 28 , 32 , 70 , 72 , 85 ]. Six studies reported data on ipsilateral CAKUT, which were present in a minority of patients [ 28 , 37 , 70 , 71 , 75 , 85 ], while in the study by Lubrano et al, 24 out of 38 had kidney scars [ 74 ]. Most of the children in these 10 studies had a GFR > 60 ml/min/1.73 m 2 , while approximately 22% of them had elevated office BP readings before ABPM.…”

“…Most of the children in these 10 studies had a GFR > 60 ml/min/1.73 m 2 , while approximately 22% of them had elevated office BP readings before ABPM. At ABPM, mean BP values were generally within the normal range, but were higher in children with CSK versus healthy controls [ 28 , 71 , 73 , 75 , 85 ] or versus children with other CAKUT [ 37 ]. The prevalence of ABPM-hypertension was reported in 8 out of 10 studies [ 28 , 37 , 70 – 75 ] (Table 7 ), with weighted mean prevalence of 27.9 ± 9.7% (Table 5 ); in the cohort of Lubrano et al, 82% of hypertensive children had kidney scars [ 74 ].…”

“…At ABPM, mean BP values were generally within the normal range, but were higher in children with CSK versus healthy controls [ 28 , 71 , 73 , 75 , 85 ] or versus children with other CAKUT [ 37 ]. The prevalence of ABPM-hypertension was reported in 8 out of 10 studies [ 28 , 37 , 70 – 75 ] (Table 7 ), with weighted mean prevalence of 27.9 ± 9.7% (Table 5 ); in the cohort of Lubrano et al, 82% of hypertensive children had kidney scars [ 74 ]. White coat hypertension was reported in six studies and was detected in a variable percentage of children (0–26%) [ 28 , 37 , 70 , 72 , 74 , 75 ].…”

“…The prevalence of ABPM-hypertension was reported in 8 out of 10 studies [ 28 , 37 , 70 – 75 ] (Table 7 ), with weighted mean prevalence of 27.9 ± 9.7% (Table 5 ); in the cohort of Lubrano et al, 82% of hypertensive children had kidney scars [ 74 ]. White coat hypertension was reported in six studies and was detected in a variable percentage of children (0–26%) [ 28 , 37 , 70 , 72 , 74 , 75 ]. The weighted mean prevalence of masked hypertension, available from six studies, was 14.3 ± 11.9% (Table 5 ) [ 28 , 37 , 70 , 72 , 74 , 75 ].…”