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Evaluation of renal injury in children with a solitary functioning kidney
Hanife Gül Balkı1, Pınar Turhan2, Cengiz Candan2
1Department of Child Health and Diseases, İstanbul Medeniyet University School of Medicine, İstanbul, Turkey.
Insights
Children with a solitary functioning kidney show early signs of renal injury, including increased blood pressure and kidney damage markers. Prolonged follow-up and ambulatory blood pressure monitoring are crucial for managing these patients.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
- Hypertension Research
Background:
- Children with a solitary functioning kidney are at increased risk for renal injury, potentially due to glomerular hyperfiltration.
- Early detection of renal damage and blood pressure abnormalities is vital for long-term outcomes.
Purpose of the Study:
- To assess early signs of renal injury in children with a solitary functioning kidney.
- To evaluate ambulatory blood pressure profiles in this patient group.
Main Methods:
- Retrospective review of children with a solitary functioning kidney and normal office blood pressure.
- Assessment of serum creatinine, urine albumin, and β2 microglobulin excretion.
- Renal ultrasound for compensatory hypertrophy and 24-hour ambulatory blood pressure monitoring (ABPM).
Main Results:
- Compensatory hypertrophy was observed in 86% of patients.
- Increased urine albumin (17%) and β2 microglobulinuria (12%) indicated kidney damage.
- ABPM revealed masked hypertension in 17% and prehypertension in 14% of children, with significantly higher BP standard deviation scores compared to controls.
Conclusions:
- Children with a solitary functioning kidney require long-term monitoring for early renal injury detection.
- Ambulatory blood pressure monitoring is essential for diagnosing and managing hypertension in these children to prevent end-organ damage.
Objective:
Children with a solitary functioning kidney have an increased risk of developing renal injury that is hypothesized to be caused by glomerular hyperfiltration. In this study, we aimed to assess the early signs of renal injury and ambulatory blood pressure profiles in children with a solitary functioning kidney.
Materials And Methods:
Data of children with normal office blood pressure measurement and a solitary functioning kidney were reviewed (serum creatinine and urine albumin and β2 microglobulin excretions), and 23 age-, weight-, and height-matched healthy children were considered as a control group. The size of the kidney was measured by renal ultrasound, and the presence of compensatory hypertrophy was calculated for all the subjects. Also, the subjects were additionally assessed for blood pressure (BP) pattern and the presence of hypertension by 24-hambulatory blood pressure monitoring.
Results:
The solitary functioning kidney demonstrated compensatory hypertrophy in 36 out of the patients (86%) at a mean age of 14.0 (SD 3.0) years. Increased urine albumin and β2 microglobulinuria, which are signs of kidney damage, were found in 7 (17%) and 5(12%) patients. Compared with the controls, patients had significantly higher mean blood pressure standard deviation scores (p>0,001), and ambulatory blood pressure monitoring identified masked hypertension in 7 (17%) children and prehypertension in 6 (14%) patients. Therefore, renal injury, defined as the presence of hypertension and/or albuminuria and/or β2 microglobulinuria and/or hypertension, was present in 36% of all children with a solitary functioning kidney.
Conclusion:
Children with a solitary functioning kidney need prolonged follow-up to detect early signs of renal injury and prevent end-organ damage later in life. Ambulatory blood pressure monitoring is an essential tool in the diagnosis and clinical management of solitary functioning kidney patients.
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