title: Risk factors for renal injury in children with a solitary functioning kidney.
abstract: OBJECTIVE
  The hyperfiltration hypothesis implies that children with a solitary functioning kidney are at risk to develop hypertension, proteinuria, and chronic kidney disease. We sought to determine the presenting age of renal injury and identify risk factors for children with a solitary functioning kidney.
  
  
  METHODS
  We evaluated 407 patients for signs of renal injury, defined as hypertension, proteinuria, an impaired glomerular filtration rate, and/or the use of renoprotective medication. Patients were subdivided on the basis of type of solitary functioning kidney and the presence of ipsilateral congenital anomalies of the kidney and urinary tract (CAKUT). The development of renal injury was analyzed with Kaplan-Meier analysis. Risk factors were identified by using logistic regression models.
  
  
  RESULTS
  Renal injury was found in 37% of all children. Development of renal injury increased by presence of ipsilateral CAKUT (odds ratio [OR] 1.66; P = .04) and age (OR 1.09; P < .001). Renal length was inversely associated with the risk to develop renal injury (OR 0.91; P = .04). In all patients, the median time to renal injury was 14.8 years (95% confidence interval 13.7-16.0 years). This was significantly shortened for patients with ipsilateral CAKUT (12.8 years, 95% confidence interval 10.6-15.1 years).
  
  
  CONCLUSIONS
  Our study determines independent risk factors for renal injury in children with a solitary functioning kidney. Because many children develop renal injury, we emphasize the need for clinical follow-up in these patients starting at birth.
authors: Department of Pediatric Nephrology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, Netherlands. r.westland@vumc.nl
authors: Rik
authors: R
authors: Westland
authors: Roel A J
authors: RA
authors: Kurvers
authors: Joanna A E
authors: JA
authors: van Wijk
authors: Michiel F
authors: MF
authors: Schreuder
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D006977:Hypertension, Renal / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000002:abnormalities* / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D008297:Male; D009426:Netherlands; D016017:Odds Ratio; D011507:Proteinuria / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014551:Urinary Tract / Q000002:abnormalities* / Q000503:physiopathology*; D014570:Urologic Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology