Fetal compensatory renal hypertrophy with a unilateral functioning kidney

Hill, Lyndon M.; Nowak, Albina; Hartle, Richard J.; Tush, Brenda

doi:10.1046/j.1469-0705.2000.00064.x

“…A hipertrofia compensatória tem sido observada em pacientes com rim solitário funcionante, embora o tempo e o grau da hipertrofia sejam controversos. Hill et al 25 , em estudo de 36 fetos com rim único funcionante, 22 dos quais com RDM, demonstraram que a hipertrofia renal compensatória estava presente em 44% dos casos após 29 semanas de gestação. John et al 19 , em estudo de 33 crianças com RDM, mostraram que 24% dos rins contralaterais tinham comprimentos excedendo +2 DP ao nascimento.…”

Section: Discussionunclassified

Conservative management of multicystic dysplastic kidney: clinical course and ultrasound outcome

Rabelo¹,

Oliveira²,

Silva³

et al. 2005

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Objective: The aim of this study was to describe the clinical course and ultrasound outcome of prenatally detected multicystic dysplastic kidney.Methods: Fifty-three children with unilateral multicystic dysplastic kidney detected by prenatal ultrasound between 1989 and 2004 were included in the analysis. All children were submitted to conservative management with follow-up visits every six months. Follow-up ultrasound examinations were performed at six-month intervals during the first two years of life and yearly thereafter. The following clinical parameters were evaluated: blood pressure, urinary tract infection, renal function, and growth. The following ultrasound parameters were evaluated: involution of multicystic dysplastic kidney and contralateral renal growth. Results:The mean follow-up time was 68 months. Two children presented hypertension during follow-up and five had urinary tract infection (only one with recurrent episodes). There was no malignant degeneration of multicystic dysplastic kidney. A total of 334 ultrasound scans were analyzed. US scan demonstrated involution of the multicystic dysplastic kidney in 48 (90%) cases, including complete involution in nine (17%). The involution rate was faster in the first 30 months of life. There was progressive compensatory renal hypertrophy of the contralateral renal unit; the rate of growth was greater in the first 24 months of life. Conclusion:The results of prolonged follow-up of children with conservatively managed multicystic dysplastic kidney suggest that clinical approach is safe, the incidence of complications is small, and that there is a clear tendency for multicystic dysplastic kidney to decrease in size. Our data also suggest that the involution rate of multicystic dysplastic kidney as well as the growth of the contralateral kidney is greater in the first 24 months of life. ResumoObjetivo: Descrever o curso clínico e a evolução ultra-sonográfica de pacientes com rim displásico multicístico tratados conservadoramente.Métodos: Foram incluídoa no estudo 53 crianças com rim displá-sico multicístico unilateral diagnosticado pela ultra-sonografia fetal entre 1989 e 2004. Todos os pacientes foram submetidos a protocolo sistemático, incluindo tratamento conservador e exames clínicos, laboratoriais e ultra-sonográficos periódicos. Os exames foram realizados com periodicidade de 6 meses, nos 2 primeiros anos, e anualmente, após esse período. No curso clínico, foram avaliados: pressão arterial, infecção do trato urinário, função renal e crescimento dos pacientes. Na evolução ecográfica, foram avaliados a involução do rim displásico multicístico e o crescimento do rim contralateral.Resultados: O tempo médio de seguimento foi de 68 meses. Dois pacientes apresentaram hipertensão arterial no seguimento. Cinco tiveram infecção urinária (apenas um com episódios repetidos). Não houve degeneração maligna do rim displásico multicístico. Foram realizados 334 exames ultra-sonográficos seriados. Houve involução do rim displásico multicístico em 90% dos casos,...

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“…Compensatory hypertrophy has been observed in patients with a single functioning kidney, although the length and grade of the hypertrophy are controversial. Hill et al, 25 in a study of 36 fetuses with a single functioning kidney, 22 of which with MDK, demonstrated that compensatory renal hypertrophy was present in 44% of cases after 29 gestational weeks. John et al, 19 in a study of 33 children with MDK, showed that 24% of contralateral kidneys had a length that exceeded +2 SD at birth.…”

Section: Discussionmentioning

confidence: 99%

Tratamento conservador do rim displásico multicístico: curso clínico e ultra-sonográfico

Rabelo¹,

Oliveira²,

Silva³

et al. 2005

J. Pediatr. (Rio J.)

0

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Objective: The aim of this study was to describe the clinical course and ultrasound outcome of prenatally detected multicystic dysplastic kidney.Methods: Fifty-three children with unilateral multicystic dysplastic kidney detected by prenatal ultrasound between 1989 and 2004 were included in the analysis. All children were submitted to conservative management with follow-up visits every six months. Follow-up ultrasound examinations were performed at six-month intervals during the first two years of life and yearly thereafter. The following clinical parameters were evaluated: blood pressure, urinary tract infection, renal function, and growth. The following ultrasound parameters were evaluated: involution of multicystic dysplastic kidney and contralateral renal growth.Results: The mean follow-up time was 68 months. Two children presented hypertension during follow-up and five had urinary tract infection (only one with recurrent episodes). There was no malignant degeneration of multicystic dysplastic kidney. A total of 334 ultrasound scans were analyzed. US scan demonstrated involution of the multicystic dysplastic kidney in 48 (90%) cases, including complete involution in nine (17%). The involution rate was faster in the first 30 months of life. There was progressive compensatory renal hypertrophy of the contralateral renal unit; the rate of growth was greater in the first 24 months of life. Conclusion:The results of prolonged follow-up of children with conservatively managed multicystic dysplastic kidney suggest that clinical approach is safe, the incidence of complications is small, and that there is a clear tendency for multicystic dysplastic kidney to decrease in size. Our data also suggest that the involution rate of multicystic dysplastic kidney as well as the growth of the contralateral kidney is greater in the first 24 months of life.J Pediatr (Rio J). 2005;81(5):400-4: Multicystic kidney, management, hypertension, ultrasonography.

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“…Thus, in affected UUA rats, severe proteinuria due to glomerular sclerosis may stress the tubular epithelium and induce interstitial infiltration, which may impair tubular concentration capacity. Enlargement of the remaining kidney has been observed in human fetuses [9,10,14] and patients [13] with a congenitally or functionally solitary kidney. In addition to being heavier than both kidneys of normal rats, the remaining right kidney in affected rats had significantly increased numbers of nephrons.…”

Section: Discussionmentioning

confidence: 99%

Age-Related Pathophysiological Changes in Rats with Unilateral Renal Agenesis

Amakasu

¹

,

Suzuki

²

,

Katayama

³

et al. 2011

The Journal of Veterinary Medical Science

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ABSTRACT. Affected rats of the unilateral urogenital anomalies (UUA) strain show renal agenesis restricted to the left side. To determine whether unilateral renal agenesis is a risk factor for the progression of renal insufficiency, we studied age-related pathophysiological alterations in affected rats. Although body growth and food intake were normal, polydipsia and polyuria with low specific gravity were present at 10 weeks and deteriorated further with age. Blood hemoglobin concentrations were normal, though there was slight erythropenia with increased MCV and MCH. Although hypoalbuminemia, hypercholesterolemia, azotemia, and hypermagnesemia were manifested after age 20 weeks, neither hyperphosphatemia nor hypocalcemia was observed. Plasma Cre and UN concentrations gradually increased with age. Cre clearance was almost normal, whereas fractional UN excretion was consistently lower than normal. Proteinuria increased with age, and albumin was the major leakage protein. In addition to cortical lesions, dilated tubules, cast formation, and interstitial fibrosis were observed in the renal medulla of 50 week-old affected rats. Renal weight was increased 1.7-fold and glomerular number 1.2-fold compared with normal rats. These findings show that the remaining kidney in UUA rats is involved not only in compensatory reactions but experiences pathophysiological alterations associated with progressive renal insufficiency.KEY WORDS: compensatory reaction, polyuria, proteinuria, renal agenesis, renal lesion.J. Vet. Med. Sci. 73(6): 787-795, 2011 There is evidence that one functioning kidney instead of two (i.e., a 50% reduction in nephron mass) may not be sufficient to support normal renal function throughout life. For example, unilateral nephrectomy (UNx) in adult rats was found to reduce GFR [5,22], increase urinary volume [5], and decrease urinary maximum concentrating capacity [22]. Moreover, neonatal UNx resulted in systemic hypertension [34] and overt proteinuria [22], as well as a marked reduction in GFR. These observations suggest that the renal function of the remaining kidney deteriorates more severely when UNx is performed during the neonatal period than during adulthood. Unilateral renal agenesis (URA) is a common congenital anomaly of the kidney [24], occurring in 1:1,000 to 1:500 persons [33]. The incidences of proteinuria, hypertension, and renal insufficiency have been reported to be higher in human patients with URA and one normal kidney than in individuals with two normal kidneys [4]. The pathogenesis and course of these manifestations in the remaining kidney of patients with URA have not been well investigated, due, perhaps in part, to the absence of suitable animal models of human URA.We previously reported the foundation and establishment of a new rat strain, the UUA (Unilateral Urogenital Anomalies) strain, characterized by URA and malformations of reproductive organs restricted to the left side. The URA was inherited as polygenic trait with the incidence of 20-60% in the strain [2]. The remaining ...

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Fetal compensatory renal hypertrophy with a unilateral functioning kidney

Abstract: Compensatory renal hypertrophy is detectable in utero and may occur as early as 22 weeks' gestation.

Cited by 52 publications

References 12 publications

Conservative management of multicystic dysplastic kidney: clinical course and ultrasound outcome

Conservative management of multicystic dysplastic kidney: clinical course and ultrasound outcome

Tratamento conservador do rim displásico multicístico: curso clínico e ultra-sonográfico

Age-Related Pathophysiological Changes in Rats with Unilateral Renal Agenesis

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