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Kidney injury associated with congenital single kidney.pdf...

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ORIGINAL ARTICLEA clinical predictive model of renal injury in children with congenitalsolitary functioning kidneyIsabel V. Poggiali1&Ana Cristina Simões e Silva1&Mariana A. Vasconcelos1&Cristiane S. Dias1&Izabella R. Gomes1&Rafaela A. Carvalho1&Maria Christina L. Oliveira1&Sergio V. Pinheiro1&Robert H. Mak2&Eduardo A. Oliveira1,2Received: 20 July 2018 /Revised: 13 September 2018 /Accepted: 2 October 2018 /Published online: 15 October 2018#IPNA 2018AbstractBackgroundSolitary functioning kidney (SFK) is an important condition in the spectrum of congenital anomalies of the kidneyand urinary tract. The aim of this study was to describe the risk factors for renal injury in a cohort of patients with congenital SFK.MethodsIn this retrospective cohort study, 162 patients with SFK were systematically followed up (median, 8.5 years). Theprimary endpoint was time until the occurrence of a composite event of renal injury, which includes proteinuria, hypertension,and chronic kidney disease (CKD). A predictive model was developed using Cox proportional hazards model and evaluated bycstatistics.ResultsAmong 162 children with SFK included in the analysis, 132 (81.5%) presented multicystic dysplastic kidney, 20 (12.3%)renal hypodysplasia, and 10 (6.2%) unilateral renal agenesis. Of 162 patients included in the analysis, 10 (6.2%) presentedpersistent proteinuria, 11 (6.8%) had hypertension, 9 (5.6%) developed CKD stage3, and 18 (11%) developed the compositeoutcome. After adjustment by the Cox model, three variables remained as independent predictors of the composite event:creatinine (HR, 3.93;P< 0.001), recurrent urinary tract infection (UTI) (HR, 5.05;P= 0.002), and contralateral renal length atadmission (HR, 0.974;P= 0.002). The probability of the composite event at 10 years of age was estimated as 3%, 11%, and 56%for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P< 0.001).ConclusionOur findings have shown an overall low risk of renal injury for most of infants with congenital SFK. Nevertheless,our prediction model enabled the identification of a subgroup of patients with an increased risk of renal injury over time.KeywordsSolitary kidney.Chronic kidney disease.Hypertension.Proteinuria.Urinary tract infectionIntroductionCongenital anomalies of the kidney and urinary tract (CAKUT)are the most common cause of birth defects [1,2]. In recent years,it has become clear that a solitary functioning kidney (SFK) is animportant condition in the spectrum of CAKUT [3].Longitudinal clinical studies have consistently shown that long-term clinical outcome of these patients is not as good as it thoughtbefore. For instance, Sanna-Cherchi et al. [4] reported data on312 CAKUT patients followed until age 30 years and showedthat the risk for dialysis was significantly higher for patients withSFK. Using a systematic review, Westland et al. [5] evaluated theoccurrence of hyperfiltration injury in 43 published cohorts ofunilateral renal agenesis. Analysis of data on 2684 patients iden-tified hypertension in 16% of the patients, albuminuria in 21%,and reduced glomerular filtration rate (GFR) in 10%.

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Term
Fall
Professor
NoProfessor
Tags
Nephrology, renal injury

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