Life with one kidney

Schreuder, Michiel F.

doi:10.1007/s00467-017-3686-4

Cited by 43 publications

(39 citation statements)

References 96 publications

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“…The dysregulation of BP mainly for systolic values in our cohort should be consistent with the hypothesis of extracellular fluid expansion [23]. Therefore, avoiding excessive salt intake, which is a common characteristic of Western diets and is implicated in cardiovascular disease, appears to be indicated from childhood in children with CSK, as also highlighted in two recent reviews [24,25].…”

Section: Discussionsupporting

confidence: 87%

Born with a solitary kidney: at risk of hypertension

Scola

Marra

Ammenti³

et al. 2020

Pediatr Nephrol

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Background Subjects with a congenital solitary kidney (CSK) are believed to be at risk of hypertension due to their low number of nephrons. However, as CSK is a congenital abnormality of the kidney or urinary tract (CAKUT), subtle dysplastic changes contributing to hypertension cannot be excluded. Methods We retrospectively compared office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM) between two groups of children with CAKUT, aged 6-18 years: Group A with a CSK and Group B with two kidneys. All had normal renal parenchyma on scintigraphy and normal renal function. OBP and mean systolic and diastolic 24-h, daytime and nighttime ambulatory BP records were analyzed. The distribution of OBP and APBM as continuous values and the prevalence of hypertension (ambulatory/severe ambulatory or masked hypertension) in the two groups were compared. Results There were 81 patients in Group A and 45 in Group B. Median OBP standard deviation scores were normal in both groups, without significant differences. Median ABPM standard deviation scores, although normal, were significantly higher in Group A and the prevalence of hypertension was higher (ambulatory/severe ambulatory or masked) (33.3 vs. 13.3%, p = 0.019), mainly because of the greater occurrence of masked hypertension. Conclusions Our data show that a CSK per se can be associated with an increased risk of hypertension from the pediatric age. Therefore, ABPM, which has proved valuable in the screening of hypertension, is warranted in children with a CSK, even if laboratory and imaging assessment is otherwise normal.

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Section: Discussionsupporting

confidence: 87%

Born with a solitary kidney: at risk of hypertension

Scola

Marra

Ammenti³

et al. 2020

Pediatr Nephrol

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“…97 The current fixed GFR threshold of 60 ml/min per 1.73 m 2 not only results in overdiagnosis of CKD in the older adults, it may also lead to missed diagnoses of CKD in younger individuals who lack overt signs of kidney damage and have a GFR above the fixed threshold of 60 ml/min per 1.73 m 2 but below the lowest percentile for their age. This group may include young people with low-nephron endowment, such as individuals born with a single kidney, 145 those born preterm 146 or at a low birth weight, patients with Down syndrome, 147 or young people with a past history of treatment with nephrotoxic drugs. 148 Such individuals are at risk for developing progressive CKD over their remaining lifetime, and may experience associated comorbidities and adverse events, including an increase in mortality.…”

Section: Potential Effect Of An Updated Definition Of Ckdmentioning

confidence: 99%

CKD: A Call for an Age-Adapted Definition

Delanaye

Jager

Bökenkamp

et al. 2019

JASN

263

242

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Current criteria for the diagnosis of CKD in adults include persistent signs of kidney damage, such as increased urine albumin-to-creatinine ratio or a GFR below the threshold of 60 ml/min per 1.73 m2. This threshold has important caveats because it does not separate kidney disease from kidney aging, and therefore does not hold for all ages. In an extensive review of the literature, we found that GFR declines with healthy aging without any overt signs of compensation (such as elevated single-nephron GFR) or kidney damage. Older living kidney donors, who are carefully selected based on good health, have a lower predonation GFR compared with younger donors. Furthermore, the results from the large meta-analyses conducted by the CKD Prognosis Consortium and from numerous other studies indicate that the GFR threshold above which the risk of mortality is increased is not consistent across all ages. Among younger persons, mortality is increased at GFR <75 ml/min per 1.73 m2, whereas in elderly people it is increased at levels <45 ml/min per 1.73 m2. Therefore, we suggest that amending the CKD definition to include age-specific thresholds for GFR. The implications of an updated definition are far reaching. Having fewer healthy elderly individuals diagnosed with CKD could help reduce inappropriate care and its associated adverse effects. Global prevalence estimates for CKD would be substantially reduced. Also, using an age-specific threshold for younger persons might lead to earlier identification of CKD onset for such individuals, at a point when progressive kidney damage may still be preventable.

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“…Despite these discrepancies, collectively in these studies it was shown that a congenital SFK does incur a greater predisposition for hypertension and kidney dysfunction later in life. However, there is a need for large long-term follow up studies beyond adolescence in individuals with a congenital SFK, as kidney dysfunction may develop later in life ( Kolvek et al, 2014 ; Schreuder, 2017 ). It would be highly desirable to determine at diagnosis of SFK, which children have a poor prognosis and for this, accurate and sensitive biomarkers need to be identified.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Physiology and Pathophysiology of Compensatory Adaptations of a Solitary Functioning Kidney

et al. 2020

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Children born with a solitary functioning kidney (SFK) have an increased risk of hypertension and kidney disease from early in adulthood. In response to a reduction in kidney mass, the remaining kidney undergoes compensatory kidney growth. This is associated with both an increase in size of the kidney tubules and the glomeruli and an increase in single nephron glomerular filtration rate (SNGFR). The compensatory hypertrophy and increase in filtration at the level of the individual nephron results in normalization of total glomerular filtration rate (GFR). However, over time these same compensatory mechanisms may contribute to kidney injury and hypertension. Indeed, approximately 50% of children born with a SFK develop hypertension by the age of 18 and 20–40% require dialysis by the age of 30. The mechanisms that result in kidney injury are only partly understood, and early biomarkers that distinguish those at an elevated risk of kidney injury are needed. This review will outline the compensatory adaptations to a SFK, and outline how these adaptations may contribute to kidney injury and hypertension later in life. These will be based largely on the mechanisms we have identified from our studies in an ovine model of SFK, that implicate the renal nitric oxide system, the renin angiotensin system and the renal nerves to kidney disease and hypertension associated with SFK. This discussion will also evaluate current, and speculate on next generation, prognostic factors that may predict those children at a higher risk of future kidney disease and hypertension.

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Life with one kidney

Cited by 43 publications

References 96 publications

Born with a solitary kidney: at risk of hypertension

Born with a solitary kidney: at risk of hypertension

CKD: A Call for an Age-Adapted Definition

Physiology and Pathophysiology of Compensatory Adaptations of a Solitary Functioning Kidney

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