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

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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.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Bambino Gesú Hospital, Rome, Italy

    Marco Cavallini, Giacomo Di Zazzo, Luca Dello Strologo, Francesco Emma & Maria Chiara Matteucci

  2. Division of Pediatric Cardiology, Bambino Gesú Hospital, Rome, Italy

    Ugo Giordano & Giacomo Pongiglione

  3. Renal Transplantation Unit, Bambino Gesú Hospital, Rome, Italy

    Nicola Capozza

  4. Division of Nephrology and Dialysis, Department of Nephrology and Urology, Ospedale Bambino Gesù - IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy

    Maria Chiara Matteucci

Authors
  1. Marco Cavallini
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  2. Giacomo Di Zazzo
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  3. Ugo Giordano
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  4. Giacomo Pongiglione
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  5. Luca Dello Strologo
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  7. Francesco Emma
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  8. Maria Chiara Matteucci
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Correspondence to Maria Chiara Matteucci.

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Cavallini, M., Di Zazzo, G., Giordano, U. et al. Long-term cardiovascular effects of pre-transplant native kidney nephrectomy in children. Pediatr Nephrol 25, 2523–2529 (2010). https://doi.org/10.1007/s00467-010-1638-3

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  • DOI: https://doi.org/10.1007/s00467-010-1638-3

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