Westland Rik, Schreuder Michiel F, van der Lof David F, Vermeulen Annemieke, Dekker-van der Meer Inge M J, Bökenkamp Arend, van Wijk Joanna A E
Department of Pediatric Nephrology, VU University Medical Center, PO Box 7057, 1007MB, Amsterdam, The Netherlands,
Pediatr Nephrol. 2014 Nov;29(11):2205-11. doi: 10.1007/s00467-014-2853-0. Epub 2014 Jun 9.
Children with a solitary functioning kidney are at increased risk of developing chronic kidney disease. Hypertension may be an early indicator of renal dysfunction in these patients. We determined blood pressure (BP) profiles of children with a solitary functioning kidney by using ambulatory BP monitoring (ABPM).
To assess the occurrence with (pre)hypertension, we compared ABPM to office BP measurement in 47 children with a solitary functioning kidney. None of the subjects used antihypertensive agents or had been hypertensive during previous clinical visits.
Mean age of study subjects was 12.7 (±3.3) years. Hypertension was identified in ten (21 %) subjects with ABPM, whereas only two (4 %) children were hypertensive during office BP measurement (p < 0.01). Fifteen (32 %) children had an ABPM standard deviation (SD) value ≥90th percentile versus six (13 %) subjects based on office BP measurement (p = 0.051). Although 24-h ABPM SD scores were higher in the congenital type than in the acquired type of solitary functioning kidney (p ≤ 0.01), the proportions of subjects with 24-h ABPM hypertension were similar between groups (congenital 25 % versus acquired 16 %; p = NS).
Based on ABPM, one in five children with a solitary functioning kidney has hypertension. As the majority of these subjects were not hypertensive during office BP measurements, ABPM should be considered in the clinical management of solitary functioning kidney patients.
单肾患儿患慢性肾病的风险增加。高血压可能是这些患者肾功能不全的早期指标。我们通过动态血压监测（ABPM）来确定单肾患儿的血压（BP）情况。
为评估（预）高血压的发生率，我们对47名单肾患儿的ABPM和诊室血压测量结果进行了比较。所有受试者均未使用抗高血压药物，且既往临床就诊时均未患高血压。
研究对象的平均年龄为12.7（±3.3）岁。ABPM检测发现10名（21%）受试者患有高血压，而诊室血压测量时只有2名（4%）儿童患高血压（p<0.01）。15名（32%）儿童的ABPM标准差（SD）值≥第90百分位数，而基于诊室血压测量的这一比例为6名（13%）受试者（p=0.051）。虽然先天性单肾患儿的24小时ABPM标准差得分高于后天性单肾患儿（p≤0.01），但两组间24小时ABPM高血压患者的比例相似（先天性25%，后天性16%；p=无显著性差异）。
基于ABPM，五分之一的单肾患儿患有高血压。由于这些受试者中的大多数在诊室血压测量时未患高血压，因此在单肾患者的临床管理中应考虑采用ABPM。
