The natural history of solitary post-nephrectomy kidney in a pediatric population
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Published on: July 18, 2025
Sanchez Basto Catalina1, Puerto Nino Angie Katherine1, Fernandez Nicolas2
1Pontificia Universidad Javeriana, Bogotá, Colombia.
Insights
Children with one kidney after nephrectomy face risks of high blood pressure and kidney disease. Early detection and long-term monitoring are crucial for managing potential renal injury in these patients.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
- Oncology
Background:
- Children with a solitary post-nephrectomy kidney (SNK) are at increased risk for long-term renal complications.
- Adaptive mechanisms to reduced nephron mass can lead to kidney disease later in life.
Purpose of the Study:
- To determine the prevalence and onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption, and renal tubular acidosis (RTA) in children with SNK.
Main Methods:
- Retrospective review of medical records for patients under 18 who underwent unilateral nephrectomy (UNP) between 2005 and 2015.
- Analysis of data from three university hospitals.
Main Results:
- Of 43 patients, 35 had UNP for non-oncologic reasons and 8 for Wilm's tumor.
- In non-oncologic cases, 9.3% developed hypertension (onset 7.1 yrs), 25% proteinuria (onset 2.2 yrs), and 21.8% GFR deterioration (onset 3.4 yrs).
- 43.5% developed de novo renal injury; oncologic cases showed slower progression and no proteinuria.
Conclusions:
- Nephrectomy does not prevent long-term renal injury in children.
- Long-term surveillance and a multidisciplinary approach are essential for managing children with SNK to detect renal injury early.
Introduction:
Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK.
Materials And Methods:
After obtaining the approval from our institution's ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals.
Results:
We identifi ed 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm's tumor was identified in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncolo-gic disease developed the conditions slowly and none of them developed proteinuria.
Conclusions:
Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.
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