Risk Factors for Renal Injury in Children with a Solitary Functioning Kidney

Westland, Rik; Kurvers, Roel A. J.; Wijik, Joanna A. E. van; Schreuder, Michiel F.

doi:10.3165/jjpn.26.127

Cited by 12 publications

(27 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the follow-up of children with a solitary functioning kidney and complex CAKUT, a multidisciplinary approach, involving general pediatricians, pediatric nephrologists, and pediatric urologists, is mandatory to optimize renal outcome, particularly when surgical intervention is necessary. Puberty seems to be a critical time in renal injury development (13), when growth spurt and associated increases in metabolic demands may drive glomerular hyperfiltration to maintain normal GFR. Other explanations for the increase in renal injury may be found in sex hormones that could affect renal outcome (58).…”

Section: Discussionmentioning

confidence: 99%

“…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). It must be noted that many of the underlying causes (e.g., CAKUT) leading to an acquired solitary functioning kidney in childhood are already present before birth, whereas some patients with a congenital solitary functioning kidney have hypodysplasia of the remnant kidney.…”

Section: Clinical Outcomementioning

confidence: 99%

“…Based on two systematic reviews and meta-analyses of the literature describing over 2000 patients with URA and MCDK (8,10), nearly one in three patients has ipsilateral CAKUT, including VUR, PUJO, a megaureter, or a duplex kidney. Although the prevalence of ipsilateral CAKUT in patients with an acquired solitary functioning kidney has not yet been established, a large cohort study suggests even higher proportions (13).…”

Section: Ipsilateral Cakutmentioning

confidence: 99%

“…To prospectively study the prognosis of a solitary functioning kidney in childhood, we designed the KIdney of MONofunctional Origin (KIMONO) study (13). This longitudinal follow-up study from The Netherlands includes over 400 children with both types of solitary functioning kidney.…”

Section: Clinical Outcomementioning

confidence: 99%

See 3 more Smart Citations

Clinical Implications of the Solitary Functioning Kidney

Westland

Schreuder

Goudoever

et al. 2014

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Clinical Outcomementioning

confidence: 99%

Section: Ipsilateral Cakutmentioning

confidence: 99%

Section: Clinical Outcomementioning

confidence: 99%

See 2 more Smart Citations

Clinical Implications of the Solitary Functioning Kidney

Westland

Schreuder

Goudoever

et al. 2014

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

show abstract

“…The outcome is not influenced by the type of SFK (congenital or acquired). 5 These data, along with the results from the study by Sanna-Cherchi et al, 6 indicate that 20% to 50% of study young adults with CSFK required dialysis by the age of 30 years, and these results were the basis for the recommendation to monitor all patients with SFK from early childhood. 7,8 Dietary protein restriction is accepted as one of the mainstays in the treatment to slow the progression of chronic kidney disease, even considering diet-regime inaccuracy.…”

mentioning

confidence: 89%

Dietary Therapy for Children With Congenital Solitary Functioning Kidney

Katzir

Biro

Cernes

et al. 2015

ICAN: Infant, Child, & Adolescent Nutrition

View full text Add to dashboard Cite

Background. Renal injury, proteinuria, and hypertension, are consequences of congenital solitary functioning kidney (CSFK). Renal injury appears around 10 years of age and requires dialysis by the age of 30 years. Low protein intake attenuated renal damage in animal experimental models, uninephrectomized patients, and kidney transplant donors and recipients. Low salt intake facilitates blood pressure control. Objective. Relevant data concerning CSFK patients have not been described so far. We decided to examine long-term preventing effects of protein restriction and low-salt diet on proteinuria, kidney function, and hypertension, in this distinct polulation. Methods. Twenty-eight children with CSFK were included in a prospective observational exposure series. Following parents’ agreement, protein and salt restriction—0.85 × recommended daily allowance (RDA)—was started under dietitian supervision. Compliance verification was performed by (a) monitoring urinary urea nitrogen and body weight, (b) measuring 24-hour urine sodium. Follow-up (8-22 years, mean 15.8 years) included clinical, growth and developmental assessment, renal function, and urine protein excretion. Results. Baseline data showed normal physical assessment, arterial blood pressure kidney functions, and urinalysis. One patient had ipsilateral kidney malformation and 2 patients had systemic pathologies. Adherence to dietary restrictions: 89 ± 8% for protein and 93 ± 5% salt. At the end of follow-up, 2 patients had chronic kidney disease grade I. None had hypertension, proteinuria, or growth and development deterioration. Conclusion. Strict follow-up and controlled dietary supervision for mild protein and salt restriction prevent kidney injury proteinuria and hypertension in CSFK, without insults on growth and development.

show abstract

Impaired ability to modulate glomerular filtration rate in aged female sheep following fetal uninephrectomy

et al. 2014

View full text Add to dashboard Cite

Fetal uninephrectomy (uni‐x) results in hypertension at a later age in female than male sheep. We hypothesized that dysregulation of tubular sodium handling contributes to the reduced ability to regulate extracellular fluid (ECF) homeostasis in older females born with a congenital nephron deficit. Following renal excretory balance studies, the response to inhibition of the Na+K+2Cl− cotransporter with furosemide (0.5 mg/kg bolus + 1 mg/kg per hour, i.v) or vehicle treatment was examined in conscious 5‐year‐old female uni‐x (n = 7) and sham (n = 7) sheep. Balance studies in meal‐fed sheep demonstrated that while average 24 h sodium excretion over 6 days was not different between the groups, the daily variation in sodium excretion was significantly greater in uni‐x compared to sham sheep (31 ± 4% vs. 12 ± 2%; P < 0.001). Basal plasma renin activity (PRA) and renal cortical cyclooxygenase‐2 (COX‐2) gene expression were lower in uni‐x sheep (both, P < 0.01). The increases in glomerular filtration rate (GFR) and renal blood flow observed in sham sheep in response to furosemide were significantly attenuated in uni‐x sheep (both PGROUP×TREAT < 0.05). However, fractional sodium excretion increased by a greater extent in the uni‐x (4.4 ± 1.0%) as compared to the sham sheep (2.0 ± 0.4%; PGROUP×TIME < 0.05) in response to furosemide. In conclusion, fetal uni‐x was associated with altered renal sodium handling and hypertension in aged females. The impaired ability to modulate PRA and GFR in the adults with a congenital nephron deficit may reduce the capacity of the kidney to respond to gains or losses in ECF to maintain a stable internal environment.

show abstract

Risk Factors for Renal Injury in Children with a Solitary Functioning Kidney

Cited by 12 publications

References 2 publications

Clinical Implications of the Solitary Functioning Kidney

Clinical Implications of the Solitary Functioning Kidney

Dietary Therapy for Children With Congenital Solitary Functioning Kidney

Impaired ability to modulate glomerular filtration rate in aged female sheep following fetal uninephrectomy

Contact Info

Product

Resources

About