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2018 ; 33
(4
): 595-604
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Life with one kidney
#MMPMID28555299
Schreuder MF
Pediatr Nephrol
2018[Apr]; 33
(4
): 595-604
PMID28555299
show ga
Life with a solitary functioning kidney (SFK) may be different from that when
born with two kidneys. Based on the hyperfiltration hypothesis, a SFK may lead to
glomerular damage with hypertension, albuminuria and progression towards
end-stage renal disease. As the prognosis of kidney donors was considered to be
very good, having a SFK has been considered to be a benign condition. In
contrast, our research group has demonstrated that being born with or acquiring a
SFK in childhood results in renal injury before adulthood in over 50% of those
affected. Most congenital cases will be detected during antenatal ultrasound
screening, but up to 38% of cases of unilateral renal agenesis are missed. In
about 25-50% of cases of antenatally detected SFK there will be signs of
hypertrophy, which could indicate additional nephron formation and is associated
with a somewhat reduced risk of renal injury. Additional renal and extrarenal
anomalies are frequently detected and may denote a genetic cause for the SFK,
even though for the majority of cases no explanation can (yet) be found. The
ongoing glomerular hyperfiltration results in renal injury, for which early
markers are lacking. Individuals with SFK should avoid obesity and excessive salt
intake to limit additional hyperfiltration. As conditions like hypertension,
albuminuria and a mildly reduced glomerular filtration rate generally do not
result in specific complaints but may pose a threat to long-term health,
screening for renal injury in any individual with a SFK would appear to be
imperative, starting from infancy. With early treatment, secondary consequences
may be diminished, thereby providing the optimal life for anyone born with a SFK.
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