Children with solitary functioning kidney at significant risk for kidney injury
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Pediatric patients with a solitary functioning kidney are at a significant risk for developing kidney injury before adulthood, according to data published in Kidney International Reports.
“A solitary functioning kidney (SFK) is a common condition caused by congenital absence of one of the kidneys, a major malformation resulting in one nonfunctioning kidney, or unilateral nephrectomy. Previous work showed that an SFK in childhood predisposes to kidney injury (ie, high blood pressure or chronic kidney disease) later in life,” Sander Groen in ‘t Woud, MD, from Radboud University Medical Center in The Netherlands, and colleagues wrote. They added, “Although potential roles for genetic, perinatal and lifestyle-related factors have been highlighted, it is still unknown why some SFK patients develop kidney injury whereas others do not. Therefore, identification of risk factors for kidney injury in this population remains needed.”
In the study, researchers examined 944 patients with SFK born between 1993 and 2020. All patients were diagnosed with SFK before adulthood, and researchers used electronic health records to determine the cause of the SFK, exposure to potential risk factors for kidney injury and follow-up data on the presence of kidney injury.
During a 12.8-year follow-up, the four indicators of kidney injury included urine protein-creatinine ratios, blood pressure, eGFR and the use of anti-hypertensive/proteinuric medication.
Using Kaplan-Meier analysis, researchers measured survival without any kidney injury and without severe kidney injury. However, follow-up information after the age of 18 was not included in the survival analyses.
Overall, researchers identified indicators of severe kidney injury among 39% of patients with a congenital SFK and 37% of patients with an acquired SFK at the age of 18. Further, any indicators of kidney injury were observed in 75% and 80% of patients, respectively.
While kidney agenesis as cause of the SFK and high body mass index at the final follow-up served as risk factors for kidney injury, these factors also correlated with proteinuria and high blood pressure. According to the study, anomalies in the SFK were associated with reduced eGFR.
“Our results may have several implications for clinical practice. The high number of patients with kidney injury indicates that all children with an SFK require long-term follow-up,” Groen in ‘t Woud and colleagues wrote. “If not already present, kidney injury may very well become manifest in early adulthood, warranting adequate transition and continued follow-up of which patients, parents, and health care providers should be aware. Follow-up of SFK patients without severe injury may best be delivered by primary care physicians and should focus on early identification of proteinuria, hypertension or a reduced eGFR. If kidney injury is discovered, local referral practices should ensure that patients are seen by the most appropriate medical specialist.”
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