Vol. 45 (6): 1227-1237, November – December, 2019
Sanchez Basto Catalina 1, Puerto Nino Angie Katherine 1, Fernandez Nicolas 2, Castillo Mariangel 3, Espitaleta Vergara Zilac 4, 5 Ana Maria Quintero Gomez 6, Perez Nino Jaime 2, 7
1 Pontificia Universidad Javeriana, Bogotá, Colombia; 2 Departamento de Urología, Pontifi cia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia; 3 Departamento de Nefrología, Hospital Universitario San Ignacio, Bogotá, Colombia; 4 Departamento de Epidemiología Clínica, Hospital Universitario San Ignacio, Bogotá, Colômbia; 5 Universidad Simon Bolivar, Bogotá, Colombia; 6 Departamento de Nefrología Universidad del Bosque, Bogotá, Colombia; 7 Departamento de Urología, Fundación Santa Fe de Bogotá
Introduction: Children with a solitary post-nephrectomy kidney (SNK) are at potential risk of developing kidney disease later in life. In response to the global decline in the number of nephrons, adaptive mechanisms lead to renal injury. The aim of this study was to determine the prevalence and time of onset of high blood pressure (HBP), proteinuria, glomerular fi ltration rate (GFR) disruption and renal tubular acidosis (RTA) in children with SNK.
Materials and methods: After obtaining the approval from our institution’s ethics committee, we reviewed the medical records of patients under 18 years of age who underwent unilateral nephrectomy between January 2005 and December 2015 in three university hospitals.
Results: We identifi ed 43 patients, 35 (81.4%) cases of unilateral nephrectomy (UNP) were due to a non-oncologic pathology and Wilm’s tumor was identifi ed in 8 (18.6%) cases. In patients with non-oncologic disease, 9.3% developed de novo hypertension, with an average time of onset of 7.1 years, 25% developed proteinuria de novo, with an average time of onset of 2.2 years. For GFR, 21.8% presented deterioration of the GFR in an average time of 3.4 years. Ten (43.5%) patients developed some type of de novo renal injury after UNP. Patients with oncologic disease developed the conditions slowly and none of them developed proteinuria.
Conclusions: Taking into account the high rate of long term postoperative renal injury, it can be considered that nephrectomy does not prevent this disease. The follow-up of children with SNK requires a multidisciplinary approach and long-term surveillance to detect renal injury.
Keywords: Solitary Kidney; Renal Insufficiency; Nephrectomy