Abstract
Objective of study: Renal mass reduction leads to glomerular hyperfiltration injury and is associated with hypertension, (micro-)albuminuria and glomerulosclerosis in animal studies. By definition, renal mass reduction exists in children with a solitary functioning kidney (SFK) and as such they are eligible for the study of glomerular hyperfiltration in humans.Methods: A retrospective chart review on hyperfiltration injury markers was performed in 232 children (117 with a congenital SFK, 115 with an acquired SFK), divided into six groups based on the SFK origin. A prediction model for estimated glomerular filtration rate (eGFR) by Schwartz-formula was developed for every diagnosis group using generalized estimated equation (GEE)-analysis. GEE-analysis utilizes all data available and is capable of handling irregular time intervals and corrects for the dependency of observations.Results: Hyperfiltration injury, defined as the presence of hypertension, the use of antihypertensive agents and/or the presence of (micro-)albuminuria, was prevalent in 44.8% of the children with a SFK at a mean age of 9.6 yrs (SD 5.7). No differences in the prevalence of hyperfiltration injury were found between children with a congenital SFK and children with an acquired SFK. In all groups, GEE-analysis showed a decline in eGFR from the beginning of puberty onwards.Conclusions: Glomerular hyperfiltration injury is present at a young age in children with a SFK, irrespective of the origin. In combination with our prediction model, these children are at increased risk to develop chronic kidney disease later in life. Therefore follow-up of children with a SFK is needed.
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