title: Renal injury in children with a solitary functioning kidney--the KIMONO study.
abstract: BACKGROUND
  Children with a solitary functioning kidney (SFK) have an increased risk of developing hypertension, albuminuria and chronic kidney disease in later life. This renal injury is hypothesized to be caused by glomerular hyperfiltration that follows renal mass reduction in animal studies. Furthermore, children with an SFK show a high incidence of congenital anomalies of the kidney and urinary tract (CAKUT), which could further compromise renal function.
  
  
  METHODS
  A retrospective study of renal injury markers was performed in 206 children, divided into groups based on the origin of SFK [primary (congenital) SFK (n = 116) and secondary SFK (n = 90)]. Data on ipsilateral CAKUT were stratified separately. For blood pressure, albuminuria and glomerular filtration rate, longitudinal models were additionally developed using generalized estimated equation analysis.
  
  
  RESULTS
  Renal injury, defined as the presence of hypertension and/or albuminuria and/or the use of renoprotective medication, was present in 32% of all children with an SFK at a mean age of 9.5 (SD 5.6) years. Children with ipsilateral CAKUT had higher proportions of renal injury (48.3 versus 24.6%, P < 0.05). Furthermore, longitudinal models showed a decrease in glomerular filtration rate in both groups from the beginning of puberty onwards.
  
  
  CONCLUSIONS
  This large cohort study demonstrates that renal injury is present in children with an SFK at a young age, whereas our longitudinal models show an increased risk for chronic kidney disease in adulthood. Renal injury is even more pronounced in the presence of ipsilateral CAKUT. Therefore, we underline that clinical follow-up of all children with an SFK is needed.
authors.affiliation: Department of Paediatric Nephrology, VU University Medical Centre, Amsterdam, The Netherlands. jae.vwijk@vumc.nl
authors.forename: Rik
authors.initials: R
authors.lastname: Westland
authors.forename: Michiel F
authors.initials: MF
authors.lastname: Schreuder
authors.forename: Arend
authors.initials: A
authors.lastname: Bökenkamp
authors.forename: Marieke D
authors.initials: MD
authors.lastname: Spreeuwenberg
authors.forename: Joanna A E
authors.initials: JA
authors.lastname: van Wijk
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D000013:Congenital Abnormalities; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000002:abnormalities* / Q000293:injuries*; D007676:Kidney Failure, Chronic / Q000378:metabolism*; D007677:Kidney Function Tests; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D014551:Urinary Tract / Q000002:abnormalities*