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Kidney length standardized to body length predicts outcome in infants with a solitary functioning kidney

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Abstract

Background

Infants with a solitary functioning kidney (SFK) are at risk for chronic kidney injury (CKI). Lack of compensatory kidney growth (CKG) is associated with CKI, but measuring CKG is challenging since it is typically reported relative to normal kidneys. This study aims to (1) standardize SFK growth in infants, (2) investigate the relationship between standardized kidney length and clinical outcomes, and (3) use these results to develop a risk-based prediction model and local clinical pathway for SFK care.

Methods

This was a quality improvement study of 166 infants with an SFK. Linear regression was used to assess kidney growth from 0 to 180 days of life. Univariate binary regression analysis was used to identify kidney length to body length thresholds associated with the development of CKI, defined as the composite outcome of chronic kidney disease (eGFR < 60 mL/min/1.73 m2), hypertension, or proteinuria.

Results

Kidneys grew in length from 0 to 180 days, and growth was constant when standardized to body length. Over follow-up, infants with a baseline kidney length to body length ≤ 0.088 were more likely to experience CKI than the rest of the cohort (27 vs. 8%, p = 0.04). Kidney length to body length ≤ 0.088 was also significantly associated with CKI development (OR 4.17, 95% CI 1.14–15.28, p = 0.04).

Conclusions

In this study, kidney length to body length ratio was a stable CKG metric over 0–180 days, and a baseline ratio ≤ 0.088 was a risk factor for CKI. Results will aid in developing a practical, point-of-care risk assessment tool, and overarching risk-stratified clinical pathway for infants with an SFK.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology, British Columbia Children’s Hospital, University of British Columbia, British Columbia, 4480 Oak St, Vancouver, K4-150V6H 2V2, Canada

    Douglas G. Matsell, Carol Bao, Teagan Po White, Ella Chan, Eli Matsell, Dan Cojocaru & Marisa Catapang

  2. Department of Radiology, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada

    Lydia Bajno

Authors
  1. Douglas G. Matsell
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  2. Carol Bao
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  3. Teagan Po White
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  4. Ella Chan
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  5. Eli Matsell
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  6. Dan Cojocaru
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  7. Lydia Bajno
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  8. Marisa Catapang
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Correspondence to Douglas G. Matsell.

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Matsell, D.G., Bao, C., White, T.P. et al. Kidney length standardized to body length predicts outcome in infants with a solitary functioning kidney. Pediatr Nephrol 38, 173–180 (2023). https://doi.org/10.1007/s00467-022-05544-y

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  • DOI: https://doi.org/10.1007/s00467-022-05544-y

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