論文

査読有り
2016年10月

Long-term impact of unilateral hypo/dysplastic kidney in infants with primary vesicoureteral reflux

JOURNAL OF PEDIATRIC UROLOGY
  • Kimihiko Moriya
  • ,
  • Michiko Nakamura
  • ,
  • Yoko Nishimura
  • ,
  • Takeya Kitta
  • ,
  • Yukiko Kanno
  • ,
  • Hiroki Chiba
  • ,
  • Masafumi Kon
  • ,
  • Nobuo Shinohara

12
5
開始ページ
287.e1
終了ページ
287.e6
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1016/j.jpurol.2016.02.015
出版者・発行元
ELSEVIER SCI LTD

Introduction
Renal abnormality is not a rare finding in infants with primary VUR. The pathophysiology of the renal abnormality is considered to be congenital or acquired. Congenital hypo/dysplastic kidney is a common finding in infants with primary VUR, especially in boys. However, the long-term impact of unilateral hypo/dysplastic kidney has not been elucidated. The aim of the current study is to clarify the long-term impact of unilateral hypo/dysplastic kidney with primary vesicoureteral reflux diagnosed in infancy.
Material and methods
The medical records of patients with primary VUR detected in infancy with unilateral hypo/dysplastic kidney on initial nuclear renal scan (< 40% relative renal function) and no scar on the contralateral kidney were reviewed retrospectively. Among them, 29 patients who were followed for more than 5 years were included in this study. Their clinical outcomes including chronic kidney disease (CKD) stage using estimated glomerular filtration rate (GFR) and the incidences of hypertension and proteinuria were analyzed.
Results
Mean age at final visit was 12.4 years (range 5.9-22.2). Estimated GFR was evaluated in 26 patients at a mean age of 12.0 years (5.9-22.2). CKD stage was 1 in all. According to the guidelines of the Japanese Society of Hypertension, while none exceeded the standard level of systolic blood pressure (BP), two patients slightly exceeded the standard level of diastolic BP. In addition, no significant proteinuria was detected in all patients, although microalbuminemia was detected in 7.7% of patients.
Discussion
The prognosis of reflux nephropathy depends on the remnant renal tissue mass, that is, the number of normal nephrons. The normal congenital solitary kidney is reported to be hyperplastic with normalsized glomeruli rather than hypertrophic ones with larger nephrons, and to have better long-term outcome regarding renal function. Accordingly, we speculated that patients with unilateral hypo/dysplastic kidney would have a similar number of nephrons to those without hypo/dysplastic kidney who have no or minimal scar as far as the contralateral kidney is well preserved. Long-term outcome of the current retrospective study was consistent with our speculation in terms of estimated GFR, proteinuria, or hypertension.
Conclusions
The present study demonstrated that significant clinical findings related to unilateral hypo/dysplastic kidney detected in infancy were rarely observed in the long term. Accordingly, unilateral hypo/dysplastic kidney seems to be a benign condition. To confirm this finding, further follow-up of these patients is necessary.


リンク情報
DOI
https://doi.org/10.1016/j.jpurol.2016.02.015
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/27106531
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000389517800010&DestApp=WOS_CPL

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