Glomerular Hyperfiltration Injury in Children with a Solitary Functioning Kidney: A Prediction Model . The Kimono-Study
Mr. Rik Westland
Disclosure : The authors declare no competing interests.
13 slide(s) – 00:06:12 – English – 2010-10-25
R. Westland(1), M.F. Schreuder(2), M.D. Spreeuwenberg(3), A. Bökenkamp(1), J.A.E. van Wijk(1)
(1)Pediatric Nephrology, VU University Medical Center, Amsterdam, (2)Pediatric Nephrology, UMCN St Radboud, Nijmegen, (3)Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
Objective of study:
Renal mass reduction leads to glomerular hyperfiltration injury and is associated with hypertension, (micro-)albuminuria and glomerulosclerosis in animal studies. By definition, renal mass reduction exists in children with a solitary functioning kidney (SFK) and as such they are eligible for the study of glomerular hyperfiltration in humans.
A retrospective chart review on hyperfiltration injury markers was performed in 232 children (117 with a congenital SFK, 115 with an acquired SFK), divided into six groups based on the SFK origin. A prediction model for estimated glomerular filtration rate (eGFR) by Schwartz-formula was developed for every diagnosis group using generalized estimated equation (GEE)-analysis. GEE-analysis utilizes all data available and is capable of handling irregular time intervals and corrects for the dependency of observations.
Hyperfiltration injury, defined as the presence of hypertension, the use of antihypertensive agents and/or the presence of (micro-)albuminuria, was prevalent in 44.8% of the children with a SFK at a mean age of 9.6 yrs (SD 5.7). No differences in the prevalence of hyperfiltration injury were found between children with a congenital SFK and children with an acquired SFK. In all groups, GEE-analysis showed a decline in eGFR from the beginning of puberty onwards.
Glomerular hyperfiltration injury is present at a young age in children with a SFK, irrespective of the origin. In combination with our prediction model, these children are at increased risk to develop chronic kidney disease later in life. Therefore follow-up of children with a SFK is needed.