title: Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects.
abstract: BACKGROUND
  Pre-transplant nephrectomy is performed to reduce risks to graft and recipient. The aims of this study were to evaluate (1) indications, surgical approach, and morbidity of native nephrectomy and (2) the effects of kidney removal on clinical and biological parameters.
  
  
  METHODS
  This study was designed as a single-center retrospective cohort study in which 49 consecutive patients with uni- or bilateral native nephrectomies were identified from a total of 126 consecutive graft recipients in our pediatric kidney transplantation database between 1992 and 2011. Demographic, clinical, and laboratory details were extracted from charts and electronic records, including operation reports and pre- and post-operative clinic notes.
  
  
  RESULTS
  Of the 49 nephrectomized patients, 47% had anomalies of the kidneys and urinary tract, 22% had cystinosis, 12% had focal segmental glomerulosclerosis, and 6% had congenital nephrotic syndrome. Nephrectomy decisions were based on clinical judgment, taking physiological and psychosocial aspects into consideration. Nephrectomy was performed in patients with polyuria (>2.5 ml/kg/h) and/or large proteinuria (>40 mg/m(2)/h), recurrent urinary tract infection or (rarely) hypertension. Urine output decreased from (median) 3.79 to 2.32 ml/kg/h (-34%), and proteinuria from 157 to 100 mg/m(2)/h (-40%) after unilateral nephrectomy (p=0.005). After bilateral nephrectomy, serum albumin, protein and fibrinogen concentrations normalized in 93, 73, and 55% of nephrectomized patients, respectively. Clinically relevant procedure-related complications (peritoneal laceration, hematoma) occurred in five patients.
  
  
  CONCLUSIONS
  In summary, we demonstrate quantitatively that native nephrectomy prior to transplantation improved serum protein levels and anticipated post-transplant fluid intake needs in select children, reducing the risk of graft hypoperfusion and its postulated consequences for graft outcome.
authors.affiliation: Division of Nephrology, Montreal Children's Hospital and McGill University, 2300, rue Tupper-E222, Montreal, Quebec, Canada, H3H 1P3.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Ghane Sharbaf
authors.forename: Martin
authors.initials: M
authors.lastname: Bitzan
authors.forename: Konrad M
authors.initials: KM
authors.lastname: Szymanski
authors.forename: Lorraine E
authors.initials: LE
authors.lastname: Bell
authors.forename: Indra
authors.initials: I
authors.lastname: Gupta
authors.forename: Jean
authors.initials: J
authors.lastname: Tchervenkov
authors.forename: John-Paul
authors.initials: JP
authors.lastname: Capolicchio
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D007668:Kidney / Q000002:abnormalities / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D009392:Nephrectomy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult