Istemihan Zülal, Dirim Ahmet Burak, Uçar Ali Rıza, Bağriaçik Ceren, Kemeç Gamze, Mirioğlu Şafak, Şafak Seda, Suleymanova Vafa, Oto Özgür Akın, Artan Ayşe Serra, Yildiz Alaattin, Türkmen Aydın, Yazici Halil
Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkiye.
Division of Nephrology, Department of Internal Medicine, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Turkiye.
Turk J Med Sci. 2025 Apr 28;55(3):687-695. doi: 10.55730/1300-0144.6016. eCollection 2025.
BACKGROUND/AIM: Unilateral atrophic kidney (UAK) could be related to many etiologies that can cause chronic kidney disease in adults. There is limited data on the long-term outcome of adults with UAK in the literature.
This study included 199 adult patients with UAK. The etiology, baseline clinical/laboratory, and radiological findings were evaluated. Composite primary outcomes (CPO) (chronic kidney disease stage 5 or doubling of serum creatinine) and secondary outcomes (new-onset proteinuria (>0.5 g/day or g/g) or >50% increase in proteinuria level according to baseline, mortality, and nephrectomy requirement during follow-up) were evaluated in 166 patients with at least 3 months of follow-up.
Of 199 patients, 57.3% were female. The mean age at presentation was 44.4 years. Right and left kidney atrophy rates were 51.8% and 48.2%, respectively. Among the known etiologies, the most common was chronic pyelonephritis (17.1%, n = 34). Of 166 patients, 19 had a CPO. Patients with CPO had higher rates of hypertension (p = 0.033), proteinuria (p < 0.001), and renal artery stenosis. Baseline systolic blood pressure (p = 0.004) and serum creatinine (p < 0.001) were higher, and baseline eGFR (p < 0.001) and serum albumin (p = 0.001) were lower in these patients than in patients without CPO. Multivariate logistic regression analysis showed that baseline creatinine (p < 0.001), serum albumin (p = 0.034), and renal artery stenosis (p = 0.015) were independent risk factors for CPO.
Higher baseline serum creatinine and lower serum albumin levels were associated with poor renal prognosis in adult patients with UAK. Also, UAK due to renal artery stenosis might be associated with worse outcomes than UAK related to other etiologies.
背景/目的：单侧萎缩肾（UAK）可能与多种可导致成人慢性肾脏病的病因相关。文献中关于成人UAK长期预后的数据有限。
本研究纳入了199例成年UAK患者。对病因、基线临床/实验室及影像学检查结果进行了评估。对166例至少随访3个月的患者评估了复合主要结局（CPO，慢性肾脏病5期或血清肌酐翻倍）及次要结局（随访期间新发蛋白尿（>0.5 g/天或g/g）或蛋白尿水平较基线升高>50%、死亡率及肾切除需求）。
199例患者中，57.3%为女性。就诊时的平均年龄为44.4岁。右肾和左肾萎缩率分别为51.8%和48.2%。在已知病因中，最常见的是慢性肾盂肾炎（17.1%，n = 34）。166例患者中，19例出现CPO。出现CPO的患者高血压（p = 0.033）、蛋白尿（p < 0.001）及肾动脉狭窄发生率更高。这些患者的基线收缩压（p = 0.004）和血清肌酐（p < 0.001）更高，而基线估算肾小球滤过率（p < 0.001）和血清白蛋白（p = 0.001）低于未出现CPO的患者。多因素逻辑回归分析显示，基线肌酐（p < 0.001）、血清白蛋白（p = 0.034）及肾动脉狭窄（p = 0.015）是CPO的独立危险因素。
较高的基线血清肌酐水平和较低的血清白蛋白水平与成年UAK患者不良的肾脏预后相关。此外，因肾动脉狭窄导致的UAK可能比与其他病因相关的UAK预后更差。
