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  • Original Article
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Outcomes of prenatally diagnosed solitary functioning kidney during early life

Abstract

Objective:

To evaluate outcomes of congenital solitary functioning kidney (SFK) in early childhood.

Study design:

A retrospective study of 32 children diagnosed in utero with SFK owing to unilateral renal agenesis or multicystic dysplastic kidney and followed for 1 to 11.5 years.

Results:

SFK length was in the compensatory hypertrophy range in 45% of fetal sonographic evaluations from mid-pregnancy, and in 85% on postnatal follow-up. Glomerular filtration rate was below normal range in 44.4%, 12.5% and 0% at <1 year, age 1 to 3 years and thereafter, respectively. Hyperfiltration was detected in 18.5% and 82.6% at <1 year and >3 years, respectively. Hypertension was documented in 35% at age 1 to 3 years but in none at an older age. Proteinuria was absent in all children.

Conclusion:

Congenital SFK is apparently associated with little or no renal damage in infancy or childhood. Compensatory enlargement of the functioning kidney begins in utero and might serve as a prognostic indicator for normal renal function after birth.

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References

  1. Kerecuk L, Schreuder MF, Woolf AS . Renal tract malformations: perspectives for nephrologists. Nat Clin Pract Nephrol 2008; 4: 312–325.

    Article  Google Scholar 

  2. Dias T, Sairam S, Kumarasiri S . Ultrasound diagnosis of fetal renal anomalies. Best Pract Res Clin Obstet Gynecol 2014; 28: 403–415.

    Article  Google Scholar 

  3. Woolf AS, Hillman KA . Unilateral renal agenesis and congenital solitary functioning kidney: developmental, genetic and clinical perspectives. BJU Int 2006; 99: 17–21.

    Article  Google Scholar 

  4. Westland R, Schreuder MF, Ket JC, van Wijk JA . Unilateral renal agenesis: a systematic review on associated anomalies and renal injury. Nephrol Dial Transplant 2013; 28: 1844–1855.

    Article  Google Scholar 

  5. Hains DS, Bates CM, Ingraham S, Schwaderer AL . Management and etiology of the unilateral multicystic dysplastic kidney: a review. Pediatr Nephrol 2009; 24: 233–241.

    Article  Google Scholar 

  6. Schreuder MF, Westland R, van Wijk JAE . Unilateral multicystic dysplatic kidney: a meta-analysis of observational studies on the inicidence associated urinary tract malformations and the contralateral kidney. Nephrol Dial Transplant 2009; 24: 1810–1818.

    Article  Google Scholar 

  7. Desphande C, Hennekam RCM . Genetic syndromes and prenatally detected renal anomalies. Semin Fetal Neonatal Med 2008; 13: 171–180.

    Article  Google Scholar 

  8. Argueso LR, Ritchey ML, Boyle ET Jr, Milliner DS, Bergstralh EJ, Kramer SA et al. Prognosis of patients with unilateral renal agenesis. Pediatr Nephrol 1992; 6: 412–416.

    Article  CAS  Google Scholar 

  9. Westland R, Schreuder MF, van Goudoever JB, Sanna-Cherchi S, van Wijk JA . Clinical implications of the solitary functioning kidney. Clin J Am Soc Nephrol 2013; 9: 978–986.

    Article  Google Scholar 

  10. Hegde S, Coulthard MG . Renal agenesis and unilateral nephrectomy: what are the risks of living with a single kidney. Pediatr Nephrol 2009;.24: 439–446.

    Article  Google Scholar 

  11. Vu KH, Van Dyck M, Daniels H, Proesmans W . Renal outcome of children with one functioning kidney from birth. A study of 99 patients and review of literature. Eur J Pediatr 2008; 167: 885–890.

    Article  Google Scholar 

  12. Baudoin P, Provoost AP, Molenaar JC . Renal function up to 50 years after unilateral nephrectomy in childhood. Am J Kidney Dis 1993; 21: 603–611.

    Article  CAS  Google Scholar 

  13. Brenner BM, Lawler EL, Mackenzie HS . The hyperfiltration theory: a paradigm shift in nephrology. Kidney Int 1996; 49: 1774–1777.

    Article  CAS  Google Scholar 

  14. Sanna-Cherchi S, Ravani P, Corbani V, Parodi S, Haupt R, Piaggio G et al. Renal outcome in patients with congenital anomalies of the kidney and urinary tract. Kidney Int 2009; 76: 528–533.

    Article  Google Scholar 

  15. Westland R, Kurvers RAJ, van Wijk JAE, Schreuder MF . Risk factors for renal injury in children with a solitary functioning kidney. Pediatrics 2013; 131: e478–e485.

    Article  Google Scholar 

  16. Chitty LS, Altman DG . Charts of fetal size: kidney and renal pelvis measurements. Prenat Diagn 2003; 23: 891–897.

    Article  Google Scholar 

  17. Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA et al. New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20: 629–637.

    Article  Google Scholar 

  18. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease. Evaluation, classification and stratification. Am J Kidney Dis 2002; 39: S56.

    Google Scholar 

  19. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114: 555–576.

    Article  Google Scholar 

  20. Rosenbaum DM, Korngold E, Teele RL . Sonographic assessment of renal length in normal children. AJR Am J Roentgenol 1984; 142: 467–469.

    Article  CAS  Google Scholar 

  21. Van Vuuren SH, Van der Doef R, Cohen-Overbeek TE, Goldschmeding R, Pistorius LR, de Jong TP . Compensatory enlargement of solitary functioning kidney during fetal development. Ultrasound Obstet Gynecol 2012; 40: 665–668.

    Article  CAS  Google Scholar 

  22. Cleper R . Mechanisms of compensatory renal growth. Pediatric Endocrinol Rev 2012; 10: 152–163.

    Google Scholar 

  23. Davidson AJ . Uncharted waters: nephrogenesis and renal regeneration in fish and mammals. Pediatr Nephrol 2011; 26: 1435–1443.

    Article  Google Scholar 

  24. Lankadeva YR, Singh RR, Tare M, Moritz KM, Denton KM . Loss of a kidney during fetal life: long-term consequences and lessons. Am J Physiol Renal Physiol 2014; 306: F791–F800.

    Article  CAS  Google Scholar 

  25. Bertram JF, Douglas-Denton R, Diouf B, Hughson MD, Hoy WE . Human nephron number: implications for health and disease. Pediatr Nephrol 2011; 26: 1529–1533.

    Article  Google Scholar 

  26. Douglas-Denton R, Moritz KM, Bertram JF, Wintour EM . Compensatory renal growth after unilateral nephrectomy in the ovine fetus. J Am Soc Nephrol 2002; 13: 406–410.

    PubMed  Google Scholar 

  27. Cho JY, Moon MH, Lee YH, Kim KW, Kim SH . Measurement of compensatory hyperplasia of the contralateral kidney: usefulness for differential diagnosis of fetal unilateral empty renal fossa. Ultrasound Obstet Gynecol 2009; 34: 515–520.

    Article  CAS  Google Scholar 

  28. Hill LM, Nowak A, Hartle R, Tush B . Fetal compensatory hypertrophy with unilateral functioning kidney. Ultrasound Obstet Gynecol 2000; 15: 191–193.

    Article  CAS  Google Scholar 

  29. Abidari JM, Park KH, Kennedy WA, Shortliffe LD . Serial followup of the contralateral renal size in children with multicystic dysplastic kidney. J Urol 2002; 168: 1821–1825.

    Article  Google Scholar 

  30. Dinkel E, Bitscho J, Dittrich M, Schulte-Wissermann H, Ertel M . Renal growth in patients nephrectomized for Wilms tumor as compared to renal agenesis. Eur J Pediatr 1988;.147: 54–58.

    Article  CAS  Google Scholar 

  31. Schreuder MF . Safety in glomerular numbers. Pediatr Nephrol 2012; 27: 1881–1887.

    Article  Google Scholar 

  32. Schreuder MF, Langemeijer ME, Bökenkamp A, Delemarre-Van de Waal HA, Van Wijk JA . Hypertension and microalbuminuria in children with congenital solitary kidney. J Paediatr Child Health 2008; 44: 363–366.

    Article  Google Scholar 

  33. Siomou E, Giapros V, Papadopoulou F, Pavlou M, Fotopoulos A, Siamopoulou A . Growth and function in childhood of a normal solitary kidney from birth or from early infancy. Pediatr Nephrol 2014; 29: 249–256.

    Article  Google Scholar 

  34. Westland R, Schreuder MF, van der Lof DF, Vermeulen A, Dekker-van der Meer IM, Bökenkamp A et al. Ambulatory blood pressure monitoring is recommended in the clinical management of children with a solitary functioning kidney. Pediatr Nephrol 2014; 29: 2205–2211.

    Article  Google Scholar 

Download references

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Correspondence to R Mashiach.

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Davidovits, M., Cleper, R., Eizenberg, N. et al. Outcomes of prenatally diagnosed solitary functioning kidney during early life. J Perinatol 37, 1325–1329 (2017). https://doi.org/10.1038/jp.2017.143

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