Service de Néphrologie Pédiatrique, Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant Université de Lyon, Lyon, France.
Nephrol Dial Transplant. 2011 Jul;26(7):2188-94. doi: 10.1093/ndt/gfq659. Epub 2010 Nov 2.
Serious concerns have risen during the last decades regarding the potential role of solitary kidney (SK) in promoting systemic hypertension, proteinuria and glomerulosclerosis. The aim of the study was to assess mid- and long-term outcome of children with SK, with special highlight on the differential functional outcome of congenital and acquired forms of SK.
Ninety-seven patients (43 females) aged from 2.9 to 25 years with radiologically normal SK were divided into two groups depending on whether they had a congenital (CSK, n = 44) or an acquired SK (ASK, n = 53). Mean follow-up time with SK was 8.3 ± 3.2 and 9.1 ± 4.4 years, respectively (P = NS). Blood pressure (BP), glomerular filtration rate (GFR) measured by inulin clearance, and microalbuminuria were assessed in all patients.
Two children (2%), one in each group, had systemic hypertension confirmed by 24-h ambulatory BP monitoring, and 17 (17.5%) had a significant microalbuminuria (8 in CSK and 9 in ASK, P = NS). The overall mean GFR was 100.6 ± 15 mL/min/1.73 m(2) and was found to be inversely correlated with age and follow-up time. Seven children had a GFR <80 mL/min/1.73 m(2), all had been nephrectomized in early childhood. Interestingly, GFR was higher in CSK than in ASK group (107.2 vs. 95.2 mL/min/1.73 m(2), P < 0.01) and was negatively related to follow-up time only in the latter but not in the former group.
In the light of these results, it appears that renal function in children with SK is well preserved in short and medium term, but it seems to decline gradually with longer periods of follow-up, particularly in ASK, thus assuming a better functional adaptation in CSK. Both conditions remain yet risky and predispose children to a greater incidence of hypertension and renal impairment in later life. Thereby, careful screening should be proposed throughout childhood to detect early signs of glomerular hyperfiltration and prevent its progression to more serious complications.
在过去的几十年中，人们对孤立肾（SK）在促进全身高血压、蛋白尿和肾小球硬化中的潜在作用产生了严重的担忧。本研究的目的是评估儿童孤立肾的中、长期预后，特别强调先天性和获得性孤立肾的不同功能结果。
97 例（43 例女性）年龄 2.9 至 25 岁的影像学正常孤立肾患者，根据是否存在先天性孤立肾（CSK，n=44）或获得性孤立肾（ASK，n=53）分为两组。平均随访孤立肾时间分别为 8.3±3.2 年和 9.1±4.4 年（P=NS）。所有患者均评估血压（BP）、通过菊粉清除率测量的肾小球滤过率（GFR）和微量白蛋白尿。
两组各有 1 例（2%）患儿经 24 小时动态血压监测确诊为高血压，17 例（17.5%）患儿微量白蛋白尿显著（8 例在 CSK，9 例在 ASK，P=NS）。总体平均 GFR 为 100.6±15 mL/min/1.73 m(2)，并发现与年龄和随访时间呈负相关。7 例患儿的 GFR＜80 mL/min/1.73 m(2)，均在幼儿期行肾切除术。有趣的是，CSK 组的 GFR 高于 ASK 组（107.2 比 95.2 mL/min/1.73 m(2)，P＜0.01），仅在后一组中，GFR 与随访时间呈负相关，而在前一组中则没有。
鉴于这些结果，孤立肾患儿的肾功能在短期和中期似乎得到了很好的保留，但随着随访时间的延长，它似乎逐渐下降，尤其是在 ASK 中，因此 CSK 具有更好的功能适应性。两种情况仍然存在风险，并使儿童在以后的生活中更容易发生高血压和肾功能损害。因此，应在整个儿童期进行仔细筛查，以发现肾小球高滤过的早期迹象，并防止其进展为更严重的并发症。
