Original Article

Pediatric Nephrology

, Volume 25, Issue 12, pp 2523-2529

First online:

Long-term cardiovascular effects of pre-transplant native kidney nephrectomy in children

  • Marco CavalliniAffiliated withDivision of Pediatric Nephrology, Bambino Gesú Hospital
  • , Giacomo Di ZazzoAffiliated withDivision of Pediatric Nephrology, Bambino Gesú Hospital
  • , Ugo GiordanoAffiliated withDivision of Pediatric Cardiology, Bambino Gesú Hospital
  • , Giacomo PongiglioneAffiliated withDivision of Pediatric Cardiology, Bambino Gesú Hospital
  • , Luca Dello StrologoAffiliated withDivision of Pediatric Nephrology, Bambino Gesú Hospital
  • , Nicola CapozzaAffiliated withRenal Transplantation Unit, Bambino Gesú Hospital
  • , Francesco EmmaAffiliated withDivision of Pediatric Nephrology, Bambino Gesú Hospital
  • , Maria Chiara MatteucciAffiliated withDivision of Pediatric Nephrology, Bambino Gesú HospitalDivision of Nephrology and Dialysis, Department of Nephrology and Urology, Ospedale Bambino Gesù - IRCCS Email author 

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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.

Keywords

Renal transplantation Ventricular mass Cardiac hypertrophy Blood pressure