Congenital Solitary Kidney from Birth to Adulthood

No AccessJournal of UrologyPediatric Urology1 May 2021Congenital Solitary Kidney from Birth to AdulthoodThis article is commented on by the following:Editorial CommentEditorial Comment Pierluigi Marzuillo, Stefano Guarino, Anna Di Sessa, Pier Francesco Rambaldi, Alfonso Reginelli, Giovanna Vacca, Salvatore Cappabianca, Daniela Capalbo, Tiziana Esposito, Carla De Luca Picione, Maria Rosaria Arienzo, Grazia Cirillo, Angela La Manna, Emanuele Miraglia del Giudice, and Cesare Polito Pierluigi MarzuilloPierluigi Marzuillo *Correspondence: Department of Woman, Child and of General and Specialized Surgery, Università della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138Napoli, Italy telephone: +39-081-5665465; FAX: 0039 081 5665427; E-mail Address: [email protected] Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Stefano GuarinoStefano Guarino Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Anna Di SessaAnna Di Sessa Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Pier Francesco RambaldiPier Francesco Rambaldi Nuclear Medicine, Department of Radiological Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Alfonso ReginelliAlfonso Reginelli Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Giovanna VaccaGiovanna Vacca Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Salvatore CappabiancaSalvatore Cappabianca Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Daniela CapalboDaniela Capalbo Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Tiziana EspositoTiziana Esposito Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Carla De Luca PicioneCarla De Luca Picione Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Maria Rosaria ArienzoMaria Rosaria Arienzo Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Grazia CirilloGrazia Cirillo Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Angela La MannaAngela La Manna Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , Emanuele Miraglia del GiudiceEmanuele Miraglia del Giudice Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author , and Cesare PolitoCesare Polito Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001524AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: To evaluate the course of prenatally diagnosed and early-enrolled congenital solitary functioning kidney patients followed until adulthood and to identify risk factors for kidney injury. Materials and Methods: Among all congenital solitary functioning kidney patients followed (1993–2018), we recalled 56 patients with prenatal diagnosis and congenital solitary functioning kidney confirmation at 1–3 months of life reaching at least 18 years of age. Serum uric acid, heavy smoking (≥25 cigarettes/day) and overweight/obesity were clustered as modifiable risk factors. Kidney injury was defined by estimated glomerular filtration rate <90 ml/minute/1.73 m2 and/or 24-hour ambulatory blood pressure monitoring confirmed hypertension and/or proteinuria. Modifiable risk factors and congenital anomalies of the kidney and urinary tract (CAKUT) of congenital solitary functioning kidney were evaluated as risk factors for kidney injury. Results: The mean followup period was 21.1 years (range 18–33 years). Mild kidney injury was found in 15 out of 56 patients (26.8%). The mean age at proteinuria, reduced estimated glomerular filtration rate and hypertension onset was 19.7 years (1.2 SDS), 20.7 years (2.7 SDS), and 22 years (5.6 SDS), respectively. Patients with CAKUT of congenital solitary functioning kidney and with both CAKUT of congenital solitary functioning kidney and modifiable risk factors presented survival free from kidney injury of 0% at 22.2 and 24.2 years of age, respectively. Patients with modifiable risk factors presented 42.4% of survival at 30 years. Patients without CAKUT of congenital solitary functioning kidney nor modifiable risk factors presented 100% of survival at 30 years of age (p=0.002). The presence of CAKUT of congenital solitary functioning kidney was the only significant risk factor (HR 4.9; 95% CI 1.8–14.2; p=0.003). Conclusions: The outcomes of congenital solitary functioning kidney in early adulthood appear better than previously reported. Prompt diagnosis of congenital solitary functioning kidney, healthy lifestyle promotion and monitoring of serum uric acid may improve the prognosis of congenital solitary functioning kidney patients. References 1. : Prenatal imaging: ultrasonography and magnetic resonance imaging. Obstet Gynecol 2008; 112: 145. Google Scholar 2. : Congenital solitary kidney in childhood: not so bad. Pediatr Nephrol 2018; 33: 723. Google Scholar 3. : A clinical predictive model of renal injury in children with congenital solitary functioning kidney. Pediatr Nephrol 2019; 34: 465. Google Scholar 4. : Risk factors for renal injury in children with a solitary functioning kidney. Pediatrics 2013; 131: e478. Google Scholar 5. : Congenital solitary kidney in children: size matters. J Urol 2016; 196: 1250. Link, Google Scholar 6. : Outcomes of a cohort of prenatally diagnosed and early enrolled patients with congenital solitary functioning kidney. J Urol 2017; 198: 1153. Link, Google Scholar 7. : The dilemma of micturating cystourethrogram for congenital solitary kidney. Pediatr Nephrol 2020; 35: 1359. Google Scholar 8. : Towards adulthood with a solitary kidney. Pediatr Nephrol 2019; 34: 2311. Google Scholar 9. : Anxiety of mothers of newborns with congenital malformations in the pre-and postnatal periods. Rev Lat Am Enfermagem 2018; 26: e3080. Google Scholar 10. : Renal outcome in patients with congenital anomalies of the kidney and urinary tract. Kidney Int 2009; 76: 528. Google Scholar 11. : Kidney size in childhood sonographical growth charts for kidney length and volume. Pediatr Radiol 1985; 15: 38. Google Scholar 12. : Estimating GFR using the CKD epidemiology collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 2010; 55: 622. Google Scholar 13. World Health Organization: Obesity and overweight. Available at https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed May 14, 2020. Google Scholar 14. : Are heavy smokers different from light smokers? A comparison after 48 hours without cigarettes. JAMA 1988; 260: 1581. Google Scholar 15. : Comparison of plasma uric acid levels obtained with five different methods. Clin Chem 1957; 3: 156. Google Scholar 16. : Higher serum uric acid level is inversely associated with renal function assessed by cystatin C in a Japanese general population without chronic kidney disease: the KOBE study. BMC Nephrol 2019; 20: 117. Google Scholar 17. : Uric acid and the risks of kidney failure and death in individuals with CKD. Am J Kidney Dis 2018; 71: 362. Google Scholar 18. : Renal damage frequency in patients with solitary kidney and factors that affect progression. Int J Nephrol 2015; 2015: 876907. Google Scholar 19. : Pediatric reference ranges for acute kidney injury biomarkers. Pediatr Nephrol 2015; 30: 677. Google Scholar 20. : 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018; 39: 3021. Google Scholar 21. American Diabetes Association: Standards of medical care in diabetes-2010. Diabetes Care, suppl., 2010; 33: S11. Google Scholar 22. : Renal injury in children with a solitary functioning kidney—the KIMONO study. Nephrol Dial Transpl 2011; 26: 1533. Google Scholar 23. : Puberty is associated with increased deterioration of renal function in patients with CKD: data from the ItalKid Project. Arch Dis Child 2012; 97: 885. Google Scholar 24. : Retrospective study to identify risk factors for chronic kidney disease in children with congenital solitary functioning kidney detected by neonatal renal ultrasound screening. Medicine 2018; 97: 32. Google Scholar 25. : Effect of body mass index on estimated glomerular filtration rate levels in children with congenital solitary kidney: a cross-sectional multicenter study. J Ren Nutr 2020; 30: 261. Google Scholar 26. : Uric acid and cardiovascular disease: an update. Eur Cardiol Rev 2016; 11: 54. Google Scholar 27. : Congenital solitary kidney size at birth could predict reduced eGFR levels later in life. J Perinatol 2019; 39: 129. Google Scholar 28. : The influence of gender and sexual hormones on incidence and outcome of chronic kidney disease. Pediatr Nephrol 2012; 27: 1213. Google Scholar 29. : Urinary tract infection in the setting of vesicoureteral reflux [version 1; referees: 2 approved]. F1000Research 2016; 5: 1. Google Scholar 30. : Congenital urinary tract obstruction: the long view. Adv Chronic Kidney Dis 2015; 22: 312. Google Scholar © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByWan J (2021) This Month in Pediatric UrologyJournal of Urology, VOL. 205, NO. 5, (1250-1251), Online publication date: 1-May-2021.Related articlesJournal of UrologyFeb 26, 2021, 12:00:00 AMEditorial CommentJournal of UrologyFeb 26, 2021, 12:00:00 AMEditorial Comment Volume 205Issue 5May 2021Page: 1466-1475Supplementary Materials Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordssolitary kidney; renal insufficiency, chronic; obesity; smoking; uric acidMetricsAuthor Information Pierluigi Marzuillo Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy *Correspondence: Department of Woman, Child and of General and Specialized Surgery, Università della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138Napoli, Italy telephone: +39-081-5665465; FAX: 0039 081 5665427; E-mail Address: [email protected] More articles by this author Stefano Guarino Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Anna Di Sessa Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Pier Francesco Rambaldi Nuclear Medicine, Department of Radiological Sciences, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Alfonso Reginelli Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Giovanna Vacca Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Salvatore Cappabianca Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Daniela Capalbo Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Tiziana Esposito Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Carla De Luca Picione Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Maria Rosaria Arienzo Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Grazia Cirillo Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Angela La Manna Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Emanuele Miraglia del Giudice Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Cesare Polito Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy More articles by this author Expand All Advertisement Loading ...