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[Renal function in children with solitary kidney]
Insights
Children with a solitary kidney often experience renal overload early in life, even without other urinary tract anomalies. This study assessed kidney function using DMSA scans and urinary markers.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
- Diagnostic Biomarkers
Context:
- Solitary kidney presents unique challenges in pediatric renal health.
- Assessing renal function in children with solitary kidneys is crucial for early intervention.
- Previous studies highlight the importance of monitoring kidney function in these patients.
Purpose:
- To evaluate renal function in children with solitary kidneys using Dimercaptosuccinic acid (DMSA) renal uptake and urinary biomarkers.
- To identify early signs of renal overload in children with solitary kidneys, irrespective of associated anomalies.
- To correlate DMSA uptake rates with urinary excretion of alpha-1-microglobulin (alpha 1-MG), beta-2-microglobulin (beta 2-MG), N-acetyl-beta-D-glucosaminidase (NAG), and microalbumin.
Summary:
- Eighteen children with solitary kidneys (14 congenital, 4 acquired) underwent assessment.
- DMSA renal uptake was reduced in 10 children, with 5 showing uptake less than 70% of controls.
- Elevated urinary alpha 1-MG and microalbumin were observed in several children, often correlating with low DMSA uptake, even in those without other anomalies.
Impact:
- Findings suggest that renal overload can develop early in children with solitary kidneys, even without apparent urinary tract abnormalities.
- Early detection of renal overload through DMSA and urinary markers is vital for managing solitary kidney patients.
- This research underscores the need for vigilant monitoring of renal function in pediatric solitary kidney cases to prevent long-term complications.
Abstract:
Renal function of eighteen children with solitary kidney (14 congenital and 4 acquired) was assessed using DMSA renal uptake rate and urinary excretion of alpha 1-MG, beta 2-MG, NAG and microalbumin. Seven of the cases were associated with vesicoureteral reflux (VUR) and two with congenital hydronephrosis. These anomalies have been already treated surgically before entering this study. DMSA renal uptake rate of 8 children was the same as that of the controls (51.8 +/- 3.7%; mean +/- SD). However, the uptake rate of 10 cases were more than 2SD below the mean of the controls. In five of them, including two children with no other urinary tract anomaly, the uptake rate was less than 70% of the mean of the controls. Half of 14 children evaluated with alpha 1-MG showed high values. In 6 of these 7 cases, DMSA renal uptake rate was more than 2SD below the mean of the controls. Urinary microalbumin was not correlated with urinary alpha 1-MG or DMSA renal uptake rate. Three of 4 children with high values of urinary microalbumin were more than 10 years old. Nine of 12 children evaluated with all the indices mentioned above showed high values of urinary alpha 1-MG and/or microalbumin. Low DMSA renal uptake rate was revealed in 7 out of these 9 children including two cases without urinary tract anomaly. These results indicate that, in the cases with solitary kidney even though no other urinary tract anomaly is recognized, renal overload may have already developed in early life.