Evaluation of renal injury in children with a solitary functioning kidney

Abstract

Objective: Children with a solitary functioning kidney have an increased risk of developing renal injury that is hypothesized to be caused by glomerular hyper-filtration. In this study, we aimed to assess the early signs of renal injury and ambulatory blood pressure profiles in children with a solitary functioning kidney. Materials and Methods: Data of children with normal office blood pressure measurement and a solitary functioning kidney were reviewed (serum creatinine and urine albumin and beta 2 microglobulin excretions), and 23 age-, weight-, and height-matched healthy children were considered as a control group. The size of the kidney was measured by renal ultrasound, and the presence of compensatory hypertrophy was calculated for all the subjects. Also, the subjects were additionally assessed for blood pressure (BP) pattern and the presence of hypertension by 24-hambulatory blood pressure monitoring. Results: The solitary functioning kidney demonstrated compensatory hypertrophy in 36 out of the patients (86%) at a mean age of 14.0 (SD 3.0) years. Increased urine albumin and beta 2 microglobulinuria, which are signs of kidney damage, were found in 7 (17%) and 5(12%) patients. Compared with the controls, patients had significantly higher mean blood pressure standard deviation scores (p>0,001), and ambulatory blood pressure monitoring identified masked hypertension in 7 (17%) children and prehypertension in 6 (14%) patients. Therefore, renal injury, defined as the presence of hypertension and/or albuminuria and/or beta 2 microglobulinuria and/ or hypertension, was present in 36% of all children with a solitary functioning kidney. Conclusion: Children with a solitary functioning kidney need prolonged follow-up to detect early signs of renal injury and prevent end-organ damage later in life. Ambulatory blood pressure monitoring is an essential tool in the diagnosis and clinical management of solitary functioning kidney patients.