Retrospective study to identify risk factors for chronic kidney disease in children with congenital solitary functioning kidney detected by neonatal renal ultrasound screening
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AuthorUrisarri, Adela; Gil, Marta; Mandiá, Natalia; Aldamiz-Echevarría, Luís; Iria, Roca; González-Lamuño Leguina, Domingo; Couce, María-Luz
To evaluate the prognostic significance of factors frequently associated with a reduction in renal mass, such as prematurity, low birth
weight, and congenital anomalies of kidney and urinary tract (CAKUT), in patients with solitary functioning kidney (SFK) and
investigate signs of early renal injury due to glomerular hyperfiltration damage or dysplasia in the remaining kidney.
Retrospective observational study of congenital SFK diagnosed and followed at a tertiary care hospital over a period of 10 years in
which 32,900 newborns underwent routine neonatal abdominal ultrasound screening. We analyzed age at diagnosis, sex,
gestational age, anthropometric measurements at birth and prenatal and neonatal ultrasound findings, in addition to follow-up data
corresponding to imaging findings (ultrasound, micturating cystourethrography, dimercaptosuccinic acid renal, and scintigraphy),
ipsilateral CAKUT, compensatory hypertrophy, and renal injury in the form of albuminuria, blood pressure, and estimated glomerular
filtration rate (eGFR).
In total, 128 congenital SFK cases were detected (1 per 257 live births). Of these, 117 (91.4%) were diagnosed by neonatal
ultrasound screening and 44.5% of these had been previously identified by prenatal ultrasound. Neonatal ultrasound had a specificity
of 100% and a sensitivity of 92.1%. Forty-five patients (35.2%) had ipsilateral CAKUT and the most common type was urinary
collecting system anomalies (75.5%). Over a median follow-up of 6.3 years (1?10 years), compensatory renal hypertrophy was
observed in 81 patients (63.7%), most of whom had ipsilateral CAKUT (76.1% vs 56.6% of patients without ipsilateral CAKUT).
Albuminuria and hypertension were observed in 3.12% and 5% of patients, respectively, and both were associated with ipsilateral
CAKUT (P<.05). In addition, 75% of albuminuria cases (P=.031), 83.3% of hypertension cases (P=.004), and 100% of decreased
eGFRcases (P=.031) were significantly associated with CAKUT (renal parenchymal anomaly category), being the strongest predictor
of GFR the presence or absence of CAKUT.
Neonatal ultrasound screening is useful for the early diagnosis of SFK. The presence of ipsilateral CAKUT should be evaluated in all
patients with SFK as congenital anomalies of the renal parenchyma are associated with a poorer prognosis. Because morbidity from
CAKUTs may not develop until adulthood, patients should be closely followed throughout life.
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