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Compensatory kidney enlargement and blood pressure patterns in children with a solitary functioning kidney

Adem Yasin Köksoy1,2, Derya Bako3

  • 1Department of Pediatric Nephrology, Samsun City Hospital, Samsun, Türkiye.

The Turkish Journal of Pediatrics
|July 24, 2026
PubMed

Insights

Children with a solitary functioning kidney (SFK) showing compensatory enlargement have higher blood pressure, particularly at night. This kidney adaptation may signal underlying hemodynamic stress, requiring further study.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Health in Children
  • Renal Physiology

Background:

  • Children with a solitary functioning kidney (SFK) face risks of hypertension and kidney injury, even with compensatory renal growth.
  • The link between compensatory kidney enlargement and blood pressure abnormalities in these children is not fully understood.

Purpose of the Study:

  • To assess ambulatory blood pressure monitoring (ABPM) parameters in children with SFK.
  • To investigate the relationship between compensatory kidney enlargement and blood pressure indices in children with SFK.

Main Methods:

  • Evaluated 33 children (aged 6-18) with SFK (renal agenesis or atrophic kidneys).
  • Defined compensatory enlargement as kidney length >97.5th percentile for height.
  • Conducted anthropometric assessment, serum creatinine measurement, GFR calculation, and 24-hour ABPM, with values adjusted for age and sex.

Main Results:

  • Compensatory enlargement was observed in 51.5% of patients.
  • Children with compensatory enlargement exhibited significantly higher 24-hour and nighttime systolic blood pressure (BP) standard deviation scores (SDS).
  • Compensatory enlargement independently predicted elevated blood pressure, with kidney length SDS correlating positively with BP indices.

Conclusions:

  • Compensatory hypertrophy in SFK may be linked to altered blood pressure regulation and potential hemodynamic stress.
  • Higher nocturnal blood pressure in children with compensatory enlargement suggests subclinical issues.
  • Children with compensatory kidney enlargement may show subtle ambulatory blood pressure alterations, necessitating further research.
Abstract

Keywords:
ambulatory blood pressure measurementcompensatory hypertrophyhypertensionkidney lengthrenal adaptationsolitary functioning kidney

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