Abstract
ABSTRACTIntroduction:Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular filtration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK.Materials and methods:After obtaining the approval from our institution's ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals.Results:We identified 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm's tumor was identified in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncologic disease developed the conditions slowly and none of them developed proteinuria.Conclusions:Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.
Highlights
Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life
Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease
In response to the decreased numbers of nephrons, several adaptive mechanisms occur in the remaining ones which can manifest clinically as arterial hypertension (AHT), decreased glomerular filtration rate (GFR) and proteinuria
Summary
Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. Conclusions: Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. In response to the decreased numbers of nephrons, several adaptive mechanisms occur in the remaining ones which can manifest clinically as arterial hypertension (AHT), decreased glomerular filtration rate (GFR) and proteinuria. There are intraglomerular hemodynamic changes due to the initial hyperfiltration It starts with intrarenal vasodilatation and glomerular hypertension which causes higher glomerular volume and surface. This inflicts a mechanical pressure on the hypertrophied podocytes, producing patches in the glomerular basement membrane which leads to a scarred Bowman’s capsule and segmental sclerosis. Histopathological findings suggest focal and segmental sclerosis in these kidneys is what leads to long-term kidney disease [5, 6]
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