Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Department of Nutrition and Dietetics, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
Pediatr Nephrol. 2021 Jul;36(7):1833-1841. doi: 10.1007/s00467-020-04896-7. Epub 2021 Jan 18.
Having a low nephron number is a well-known risk factor for hypertension. There is an inverse relationship between the filtration surface area and systemic hypertension. A significant percentage of masked hypertension can be detected in children with nephron loss by ambulatory blood pressure monitoring (ABPM).
We prospectively investigated ABPM results of children having reduced kidney mass with normal office blood pressures (BPs) and kidney function. Forty-three children with congenital solitary kidney (group 1), 11 children with acquired solitary kidney (group 2), and 76 children with hypofunctioning kidney (group 3) were compared with age, gender, and BMI-matched healthy control group (group 4). The dietary salt intake of 76 patients was evaluated as salt equivalent (g/day). The primary endpoint was change from baseline in mean 24-h ABPM variables and the proportion of patients with masked hypertension when assessed by ABPM.
The masked hypertension ratio of all patients was 12.3% when assessed with ABPM. Night hypertension was significantly higher in all patient groups than in the control group (p = 0.01). Diastolic BP loads of groups 1 and 3 were higher than in controls (p = 0.024). Systolic BP loads were higher only in group 1 than in the control group (p = 0.003). The dietary salt equivalent of patients in group 1 correlated positively with 24-h SBP and mean arterial pressure (MAP) values. Patients with excessive dietary salt intake in group 1 had a significantly higher diastolic BP load than those without excessive salt intake in group 1 (p = 0.002).
Masked hypertension can be seen in children with a solitary kidney or when one of the kidneys is hypofunctioning. Systolic BP loads are higher in children with congenital solitary kidney, and salt intake correlates with systolic BP profiles especially in those. Our results suggest that being born with a congenital solitary kidney increases predisposition to hypertension and salt sensitivity.
肾单位数量少是高血压的一个已知危险因素。过滤表面积与系统性高血压呈反比关系。通过动态血压监测（ABPM）可以检测到患有肾单位丢失的儿童中有很大比例的隐匿性高血压。
我们前瞻性地研究了具有正常办公室血压（BP）和肾功能的肾单位减少的儿童的 ABPM 结果。将 43 例先天性孤立肾（第 1 组）、11 例获得性孤立肾（第 2 组）和 76 例肾功能不全的儿童（第 3 组）与年龄、性别和 BMI 匹配的健康对照组（第 4 组）进行比较。评估 76 例患者的盐摄入量作为盐当量（g/天）。主要终点是通过 ABPM 评估从基线到平均 24 小时 ABPM 变量的变化和隐匿性高血压患者的比例。
当通过 ABPM 评估时，所有患者的隐匿性高血压比例为 12.3%。所有患者组的夜间高血压均显著高于对照组（p=0.01）。第 1 组和第 3 组的舒张压负荷高于对照组（p=0.024）。仅第 1 组的收缩压负荷高于对照组（p=0.003）。第 1 组患者的饮食盐当量与 24 小时 SBP 和平均动脉压（MAP）值呈正相关。第 1 组中摄入过多盐的患者的舒张压负荷明显高于第 1 组中摄入盐不过量的患者（p=0.002）。
隐匿性高血压可见于孤立肾或单侧肾脏功能不全的儿童中。先天性孤立肾儿童的收缩压负荷较高，盐摄入量与收缩压谱相关，尤其是在那些儿童中。我们的结果表明，先天性孤立肾会增加患高血压和盐敏感性的倾向。
