Nephron. 2018;140(1):18-23. doi: 10.1159/000490200. Epub 2018 Jun 7.
BACKGROUND/AIMS: Children with a solitary functioning kidney have a risk of renal injury caused by hyperfiltration. Timely intervention with renin-angiotensin inhibitors may be beneficial. We examined whether trajectory of estimated glomerular filtration rate (eGFR) would predict renal injury, defined as microalbuminuria/proteinuria, hypertension, and/or a decline in eGFR.
Seventeen patients (male 7, female 10) with multicystic dysplastic kidney (MCDK; median age 13 years, range 6-19 years) followed in our clinic were examined retrospectively. An eGFR decline was defined as a fall to < 90 mL/min/1.73 m2 or a decline of > 5 mL/min/1.73 m2/year for those with baseline eGFR of ≥90 or < 90 mL/min/1.73 m2 respectively.
Nine patients had renal injury at the time of investigation. Compared with 8 patients without renal injury, those with renal injury tended to be older (14.7 ± 4.2 vs. 11.4 ± 4.6 years) and the birth weight was smaller (2,538 ± 281 vs. 2,966 ± 361 g, p < 0.05). The frequency of contralateral congenital anomaly of kidney and urinary tract (cyst, hydronephrosis, or vesicoureteral reflux) were not different. The trajectory of eGFR in those without renal injury was either an increase (n = 3) or unidentifiable (n = 5), whereas that in the renal injury group was exclusively an increase followed by decline (p < 0.05). The average age of the onset of eGFR decline was 9.4 ± 4.2 years and that of the start of renal injury (albuminuria/proteinuria 5, eGFR decline 4, hypertension 1) was 12.5 ± 4.2 years.
All the children with MCDK who developed renal injury had eGFR trajectory of increase followed by decline. Renal injury followed the peak eGFR by 3 years on average. This observation is in agreement with the hyperfiltration theory and underscores the importance of following eGFR trajectory closely.
背景/目的：孤立功能肾儿童存在因超滤引起的肾损伤风险。及时进行肾素-血管紧张素抑制剂干预可能有益。我们研究了估计肾小球滤过率（eGFR）的轨迹是否可以预测肾损伤，肾损伤的定义为微量白蛋白尿/蛋白尿、高血压和/或 eGFR 下降。
我们回顾性检查了在我们诊所就诊的 17 名患有多囊性发育不良肾（MCDK；中位年龄 13 岁，范围 6-19 岁）的男性 7 名，女性 10 名患者。eGFR 下降定义为基线 eGFR≥90 或<90 mL/min/1.73 m2 的患者分别下降至<90 mL/min/1.73 m2 或每年下降>5 mL/min/1.73 m2。
在调查时，9 名患者有肾损伤。与 8 名无肾损伤的患者相比，有肾损伤的患者年龄较大（14.7 ± 4.2 岁比 11.4 ± 4.6 岁），出生体重较小（2,538 ± 281 克比 2,966 ± 361 克，p < 0.05）。对侧先天性肾和尿路异常（囊肿、肾积水或输尿管反流）的发生率无差异。无肾损伤患者的 eGFR 轨迹要么是增加（n = 3），要么无法识别（n = 5），而肾损伤组的轨迹则完全是增加后下降（p < 0.05）。eGFR 下降的平均起始年龄为 9.4 ± 4.2 岁，肾损伤（微量白蛋白尿/蛋白尿 5 例，eGFR 下降 4 例，高血压 1 例）的起始年龄为 12.5 ± 4.2 岁。
所有发生肾损伤的 MCDK 儿童的 eGFR 轨迹均为先增加后下降。肾损伤平均比峰值 eGFR 晚 3 年发生。这一观察结果与超滤理论一致，强调了密切监测 eGFR 轨迹的重要性。
