Groen In 't Woud Sander, Reuver Nieke, Feitz Wout F J, Quaedackers Josine S L T, Nijman Rien, Steffens Martijn, de Wall Liesbeth L L, Roeleveld Nel, Schreuder Michiel F, van der Zanden Loes F M
Radboud university medical center, Radboud Institute for Health Sciences, Department for Health Evidence, Nijmegen, The Netherlands.
Radboud university medical center, Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Department of Pediatric Nephrology, Nijmegen, The Netherlands.
Eur Urol Open Sci. 2021 Oct 27;34:10-16. doi: 10.1016/j.euros.2021.09.008. eCollection 2021 Dec.
Compensatory hypertrophy is common in children with solitary functioning kidney, but it is unknown whether it also develops in children with unilateral partial reduction of kidney function.
The aim of this study was to assess whether children with a unilateral ureteropelvic junction obstruction (UPJO) show compensatory growth of the unaffected kidney. Furthermore, we investigated whether the length of the unaffected kidney was related to the degree of split kidney function lost and other possible risk factors. Lastly, we studied a possible relationship with signs of kidney injury.
We retrospectively analysed clinical information from 194 children with a unilateral UPJO who participated in the Aetiologic research into Genetic and Occupational/environmental Risk factors for Anomalies in children (AGORA) data- and biobank. Data on kidney length, split kidney function, and other factors possibly associated with kidney length were extracted from electronic patient records.
Pearson's correlation coefficients between the split kidney function and unaffected kidney length were calculated. Multivariable logistic regression analyses were performed to identify factors associated with kidney length and signs of kidney injury.
Most children with a UPJO had an unaffected kidney length above the reference for age at the end of follow-up (median age 6.5 yr). A correlation with split kidney function was present only in children with a split kidney function of ≥60% in the unaffected kidney ( = 0.41). Aside from split kidney function, UPJO side was the only determinant of kidney length, while no associations between kidney length and kidney injury were identified.
Compensatory growth was visible in most children with a UPJO after sufficient follow-up time and was correlated with split kidney function in children with a severe UPJO. Contralateral kidney length provided no clear prognostic value for developing kidney injury. Studies with more patients and additional biomarkers of kidney injury are needed to further personalise care.
Children with obstruction of urine outflow in one kidney often had a larger contralateral kidney. However, the size of this kidney could not be used to predict which children would develop kidney injury.
代偿性肥大在单肾功能正常的儿童中很常见，但单侧肾功能部分减退的儿童是否也会出现代偿性肥大尚不清楚。
本研究旨在评估单侧输尿管肾盂连接部梗阻（UPJO）患儿未受影响的肾脏是否会出现代偿性生长。此外，我们调查了未受影响肾脏的长度是否与分肾功能丧失程度及其他可能的危险因素有关。最后，我们研究了其与肾损伤体征之间的可能关系。
设计、地点和参与者：我们回顾性分析了194例参与儿童异常的遗传和职业/环境危险因素病因学研究（AGORA）数据及生物样本库的单侧UPJO患儿的临床信息。从电子病历中提取肾脏长度、分肾功能及其他可能与肾脏长度相关因素的数据。
计算分肾功能与未受影响肾脏长度之间的Pearson相关系数。进行多变量逻辑回归分析以确定与肾脏长度及肾损伤体征相关的因素。
大多数UPJO患儿在随访结束时（中位年龄6.5岁）未受影响肾脏的长度高于年龄参考值。仅在未受影响肾脏分肾功能≥60%的患儿中存在与分肾功能的相关性（r = 0.41）。除分肾功能外，UPJO侧是肾脏长度的唯一决定因素，而未发现肾脏长度与肾损伤之间存在关联。
经过足够的随访时间，大多数UPJO患儿出现了代偿性生长，并且在严重UPJO患儿中与分肾功能相关。对侧肾脏长度对发生肾损伤没有明确的预后价值。需要开展更多患者参与的研究以及增加肾损伤生物标志物，以进一步实现个性化治疗。
一侧肾脏尿液流出受阻的儿童，其对侧肾脏通常较大。然而，该肾脏的大小无法用于预测哪些儿童会发生肾损伤。
