Risk stratification for children with a solitary functioning kidney

Woud, Sander Groen in ‘t; Zanden, Loes F M van der; Schreuder, Michiel F.

doi:10.1007/s00467-021-05168-8

Cited by 9 publications

(5 citation statements)

References 49 publications

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“…Our results show that no indication subgroup remains sufficiently free from kidney injury to justify discharge from follow-up. Although not all patients will develop kidney injury after nephrectomy, stratification is not yet possible, which is similar to patients living with a congenital SFK [ 6 ]. Therefore, we recommend to perform screening for kidney injury in line with that performed in patients with congenital SFK, consisting of a yearly measurement of blood pressure and proteinuria and 5-yearly estimation of the GFR [ 86 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although the high rate of kidney injury led to recommendations highlighting the need for follow-up of children with an SFK, the frequency of follow-up is largely opinion-based [ 3 ]. Follow-up could be individualized if more information on risk factors for kidney injury were made be available [ 6 ]. Therefore, we addressed the following research questions in a systematic review and meta-analysis of the literature: (i) what is the prevalence of kidney injury in children who underwent a unilateral nephrectomy and, (ii) does the indication for nephrectomy influence the rate of kidney injury?…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…More than 50% of children with a SFK suffer from proteinuria or hypertension before they reach adulthood ( 2 ). Several factors have been suggested to select patients with a higher risk, such as additional CAKUT or lack of compensatory growth ( 3 ). The current guidelines advise regular follow-up with evaluation of growth, blood pressure, proteinuria, kidney function, and ultrasound of the kidney during childhood and maturity ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Case Report: Uterine Anomalies in Girls With a Congenital Solitary Functioning Kidney

2021

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Unilateral renal agenesis and multicystic dysplastic kidney, resulting in a contralateral solitary functioning kidney (SFK), are part of the broad spectrum of congenital anomalies of the kidney and urinary tract (CAKUT). In girls with SFK, screening for asymptomatic Müllerian anomalies of uterus and vagina is not yet routinely performed, and therefore often overlooked until clinical complications in the menstrual cycle or fertility process occur. In this case series, we report on four teenagers with congenital SFK presenting with menstrual problems due to a Müllerian anomaly. Routine peri-menarchal screening for Müllerian anomalies in girls with SFK may provide timely counseling, surgical treatment and prevention of associated complications such as endometriosis, infertility and miscarriages.

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“…One study reported 757 radical nephrectomies among 9002 renal trauma patients from 2002-2007 [5]. As usual, the renal function of patients with RCC of the solitary kidney is already impaired before the treatment [5][6][7], which makes the NSS approach especially significant.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Diagnostics at the Stages of Extracorporeal Resection of a Single Kidney in the Treatment of Renal Cell Carcinoma

Stepanova¹,

Raguzina²,

Baitman³

et al. 2021

RAD Conference Proceedings

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An organ-sparing approach is preferable at the treatment of patients with cancer of a solitary kidney, but doesn't always comply with the oncological radicalism. The technique of extracorporeal renal resection followed by autologous transplantation was developed to preserve renal function in patients with obligatory indications for organpreserving treatment. The aim is to evaluate the possibilities of ultrasound (US) at the stages of extracorporeal resection of a single kidney in the treatment of renal cell carcinoma. Materials and methods. The study included 22 patients treated with renal cell carcinoma of a single kidney in 2013-21 (average age 60.45±7 years). Men prevailed (73%). Multiple primary metachronous cancer occurred in 16 (73%) cases, multiple primary synchronous cancer -in 2 (9%), previous nephrureterectomy was performed in connection with benign kidney diseases (primary contracted kidney, hydronephrosis) -in 2 (10%), a congenital single kidney was in 2 (10%) patients. Previously underwent surgery on a single kidney for a malignant neoplasm of the same etiology for which 6 (27%) patients are being treated in this hospitalization. All the patients underwent US examination in B-mode and duplex scanning at the pre-/intra-and postoperative stage. If necessary, echo-contrast US (Sonovue) was performed intraoperatively and in the early postoperative period. Also, all patients underwent preoperative contrast-enhanced multidetected computed tomography (MDCT). MRI was performed in 7 cases. All the patients were operated with histological verification. Results. Staging according to the TNM system: pT1a-T3vN0-2M0-1G1-3, of which the tumor size exceeded 7 cm in 10 (50%) patients, distant metastases were in 8 (40%) cases. Reno-caval tumor thrombus was detected in 3 patients. Intraoperative US was performed at the stages of surgery: navigation to the stage of resection and assessment of the restoration of blood supply in the intervention area after kidney resection and wound closure. In 3 cases, extracorporeal renal resection was performed simultaneously with thrombectomy and resection of the inferior vena cava for renocaval tumor thrombus. In 4 cases, renal vessel replacement was performed. The tumor involved vessels in 3 cases and in 1 IOUS after resection showed thrombosis of the renal artery, which eventually required prosthetics. There were no intraoperative complications. All patients underwent US-monitoring on the 1st, 3rd and 5th days after surgery, more often and further as needed. The follow-up period (US, MSCT) was 19-85 months (53.3±17.2). Tumor progression occurred in 3 (15%) cases. One patient died due to the progression of the tumor process 20 months after the operation. Conclusion. US make it possible to control all the stages of extracorporeal resection of a single kidney under pharmacocold anti-ischemic protection with orthotopic replantation of renal vessels. The results of this surgical intervention are satisfactory, which indicates the advisability of further development of organ-saving treatm...

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Risk stratification for children with a solitary functioning kidney

Cited by 9 publications

References 49 publications

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

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

Case Report: Uterine Anomalies in Girls With a Congenital Solitary Functioning Kidney

Ultrasound Diagnostics at the Stages of Extracorporeal Resection of a Single Kidney in the Treatment of Renal Cell Carcinoma

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