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Solitary functioning kidney in paediatrics – assessment of renal impairment

Tânia Carvalho1, Telma Francisco2, Raquel Santos2, Margarida Abranches2

1 – Pediatric Department, Hospital Vila Franca de Xira, Portugal
2 – Pediatric Nephrology Unit, Hospital Dona Estefânia, CHLC-EPE, Lisbon, Portugal

- 51th Annual Scientific Meeting of the European Society for Paediatric Nephrology, Antalya (Turkey), 3-6/October/2018 (poster)

Introduction: Growing with a solitary functioning kidney (SFK) is no longer considered a benign condition. The resulting glomerular hyperfiltration is reflected in the development of hypertension, proteinuria and decreased renal function.
Objective: To characterize a population of paediatric patients with SFK over a five-year period and to determine the prevalence of risk factors for renal injury..
Material and methods: A retrospective analysis of patients with SFK´s clinical processes followed in a Pediatric Nephrology Unit of a tertiary hospital (2012-2016) was made. Hypertension was classified according to 2004 American Task Force, GFR considered decreased if less than 90 ml/min/1.73m2 and obesity defined according to WHO reference curves.
Results: We considered 167 patients, 62.9% male, mean age 7.2 ± 5.1 years. Congenital cause was identified in 80.2% those 66.4% were diagnosed antenatally, 49.2% had multicystic dysplasia and 12.6% were syndromatic. Congenital ipsilateral urinary tract abnormalities (CAKUT) were diagnosed in 11.4%. The most frequent acquired cause was tumoral (n=12/32, 37.5%). Twenty one patients had renal impairment (12.6%): proteinuria (10), hypertension (6) or GFR <60 ml/min/1.73m2 (6). Twenty children had obesity (11.9%). Renal impairment was associated with CAKUT (p=0.000) and no association was found with obesity, recurrent urinary tract infection or nephrolithiasis. In the subgroup with congenital SFK, prematurity and low birth weight showed no association with renal impairment.
Conclusions: This study highlights the relevance of follow-up since the diagnosis of SFK, with monitoring of indicators of renal impairment. We emphasized that renal function impairment may not be preceded by hypertension or proteinuria; therefore, it´s necessary to evaluate other glomerular hyperfiltration factors, like obesity..

Keywords: solitary functioning kidney, CAKUT, hypertension, proteinuria