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Do children with solitary or hypofunctioning kidney have the same prevalence for masked hypertension?
Sibel Yel1, Neslihan Günay2, Ayşe Seda Pınarbaşı2
1Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey. drsibelyel@gmail.com.
Insights
Children with reduced kidney mass, including solitary or hypofunctioning kidneys, have a higher risk of masked hypertension. Increased salt intake further elevates blood pressure in those with congenital solitary kidneys, indicating a predisposition to hypertension.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health
- Hypertension Research
Background:
- Reduced nephron number is a known risk factor for hypertension.
- An inverse relationship exists between renal filtration surface area and systemic hypertension.
- Masked hypertension in children with nephron loss can be detected using ambulatory blood pressure monitoring (ABPM).
Purpose of the Study:
- To prospectively investigate ambulatory blood pressure monitoring (ABPM) results in children with reduced kidney mass and normal office blood pressures.
- To assess the prevalence of masked hypertension in pediatric populations with congenital solitary kidneys, acquired solitary kidneys, or hypofunctioning kidneys.
- To evaluate the impact of dietary salt intake on blood pressure parameters in these pediatric groups.
Main Methods:
- Prospective investigation of 43 children with congenital solitary kidney, 11 with acquired solitary kidney, and 76 with hypofunctioning kidney, compared to a healthy control group.
- Ambulatory blood pressure monitoring (ABPM) was used to assess 24-hour blood pressure variables.
- Dietary salt intake was quantified, and its correlation with blood pressure parameters was analyzed.
Main Results:
- The overall masked hypertension rate was 12.3% in the patient groups.
- Nighttime hypertension was significantly more prevalent in all patient groups compared to controls.
- Systolic blood pressure (BP) loads were elevated in children with congenital solitary kidneys, and salt intake correlated positively with BP, particularly in this group.
Conclusions:
- Masked hypertension is prevalent in children with solitary or hypofunctioning kidneys.
- Children with congenital solitary kidneys exhibit higher systolic BP loads, and salt intake is a significant influencing factor.
- Congenital solitary kidney is associated with an increased predisposition to hypertension and salt sensitivity in children.
Background:
Having a low nephron number is a well-known risk factor for hypertension. There is an inverse relationship between the filtration surface area and systemic hypertension. A significant percentage of masked hypertension can be detected in children with nephron loss by ambulatory blood pressure monitoring (ABPM).
Methods:
We prospectively investigated ABPM results of children having reduced kidney mass with normal office blood pressures (BPs) and kidney function. Forty-three children with congenital solitary kidney (group 1), 11 children with acquired solitary kidney (group 2), and 76 children with hypofunctioning kidney (group 3) were compared with age, gender, and BMI-matched healthy control group (group 4). The dietary salt intake of 76 patients was evaluated as salt equivalent (g/day). The primary endpoint was change from baseline in mean 24-h ABPM variables and the proportion of patients with masked hypertension when assessed by ABPM.
Results:
The masked hypertension ratio of all patients was 12.3% when assessed with ABPM. Night hypertension was significantly higher in all patient groups than in the control group (p = 0.01). Diastolic BP loads of groups 1 and 3 were higher than in controls (p = 0.024). Systolic BP loads were higher only in group 1 than in the control group (p = 0.003). The dietary salt equivalent of patients in group 1 correlated positively with 24-h SBP and mean arterial pressure (MAP) values. Patients with excessive dietary salt intake in group 1 had a significantly higher diastolic BP load than those without excessive salt intake in group 1 (p = 0.002).
Conclusions:
Masked hypertension can be seen in children with a solitary kidney or when one of the kidneys is hypofunctioning. Systolic BP loads are higher in children with congenital solitary kidney, and salt intake correlates with systolic BP profiles especially in those. Our results suggest that being born with a congenital solitary kidney increases predisposition to hypertension and salt sensitivity.
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