title: Long-term cardiovascular effects of pre-transplant native kidney nephrectomy in children.
abstract: Left ventricular (LV) hypertrophy (H) and hypertension are prevalent in children with end-stage renal disease (ESRD) and after renal transplantation. Severe hypertension prior to renal transplantation has traditionally been an indication for native kidney nephrectomy. The impact of nephrectomy on cardiovascular disease has not been well documented. We retrospectively evaluated echocardiographic and ambulatory blood pressure monitoring (ABPM) data in 67 young adults who had undergone transplantation in the pediatric age with a mean follow-up of 10.4 years. Unilateral or bilateral nephrectomies had been performed in 32 patients. The number of antihypertensive drugs used prior to transplantation was significantly higher in the nephrectomized groups. At follow-up the amount of antihypertensive medications was similar between groups and no significant differences were observed in mean arterial blood pressure (MAP) or LV mass index (LVMi). LVH was observed in 50% of non-nephrectomized patients, 45.4% of patients with unilateral nephrectomy, and 44.4% of patients without native kidneys (p = n.s.). In conclusion, unilateral or bilateral nephrectomies prior to transplantation do not appear to influence blood pressure control or the prevalence of LVH after renal transplantation. Longitudinal studies with repeated assessment of LVMi, before and after renal transplantation, are needed to assess the impact of residual activity of native kidneys on arterial blood pressure and cardiac structural changes, even in normotensive patients, to evaluate cardiovascular morbidity.
authors.affiliation: Division of Pediatric Nephrology, Bambino Gesú Hospital, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cavallini
authors.forename: Giacomo
authors.initials: G
authors.lastname: Di Zazzo
authors.forename: Ugo
authors.initials: U
authors.lastname: Giordano
authors.forename: Giacomo
authors.initials: G
authors.lastname: Pongiglione
authors.forename: Luca
authors.initials: L
authors.lastname: Dello Strologo
authors.forename: Nicola
authors.initials: N
authors.lastname: Capozza
authors.forename: Francesco
authors.initials: F
authors.lastname: Emma
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Matteucci
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012384:Rome; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents