Pediatric patients with a solitary functioning kidney are at risk for kidney injury
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By the age of 15 years, one-third of patients in a study from the Netherlands experienced one or more signs of kidney injury, leading researchers to believe the cause of solitary functioning kidney may impact the risk of kidney injury.
“Solitary functioning kidney (SFK) is a prevalent condition affecting over 5,000 newborns and, on top of that, several thousands of children undergo nephrectomy, adding up to over 100,000 children living with SFK worldwide,” Sander Groen in 't Woud, MD, a PhD candidate at Radboundumc University Medical Center in the Netherlands, said at ASN Kidney Week during his presentation of results from the Solitary Functioning Kidney: Aetiology and Prognosis (SOFIA) study. “The exact risk and risk factors for kidney injury are still unknown. We aimed to get more insight into this by creating a nationwide cohort study of patients with SFK.”
Researchers recruited and observed children with congenital and acquired SFK who were treated in hospitals throughout the Netherlands. Electronic patient files provided information on risk factors for and signs of kidney injury in patients, such as proteinuria, blood pressure and GFR. Researchers used Kaplan-Meier curves to predict survival without signs of kidney injury and used Cox regression to measure risk factors.
Investigators found 91% of patients who provided consent had available detailed clinical information.
A median follow-up duration of 9.7 years revealed proteinuria in 15% of patients, high blood pressure in 22% of patients and a GFR of less than 60 mL/min/1.73 m2 in 3.2% of patients, while antihypertensive medication was used by 9.8% patients.
Overall, 36% of patients showed less than or at least one sign of kidney injury. Although the median age at first sign of kidney injury was 4.4 years, the cumulative proportions of children with kidney injury were 20% at 5 years, 29% at 10 years and 35% at 15 years of age.
Researchers found kidney injury rates were higher in patients with a congenital cause of SFK compared with an acquired cause, and higher in patients with unilateral renal agenesis compared with multicyclic dysplastic kidney.
“We observed that children [who] developed SFK after posterior urethral valves or unilateral renal agenesis had a higher risk of kidney injury than children who had an SFK caused by for instance, bloody cystic kidney displays,” Woud said. “Furthermore, we also saw that children who go through a urinary tract infection in the first year of life have higher risks of injury compared to patients who did not experience a urinary tract infection.”
Researchers noted the cause of the SFK may influence the risk of kidney injury.
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Woud SG, et al. Risk factors for kidney injury in children with solitary functioning kidney. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
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