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Nierschade bij kinderen met een mononier

De KIMONO-studie

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Tijdschrift voor Kindergeneeskunde

Samenvatting

Inleiding

Kinderen met een mononier hebben mogelijk een verhoogd risico op het ontwikkelen van hypertensie, (micro)albuminurie en chronische nierinsufficiëntie.Twee oorzaken hiervoor zouden glomerulaire hyperfiltratie en de hoge incidentie van congenitale afwijkingen van nieren en urinewegen (CAKUT) kunnen zijn. De KIMONO-studie inventariseert het bestaan van tekenen van nierschade op de kinderleeftijd in een groot cohort van kinderen met een mononier.

Patiënten en methoden

Tekenen van nierschade (hypertensie, microalbuminurie en antihypertensieve/antiproteïnurische medicatie) werden retrospectief geëvalueerd in 206 kinderen met een mononier (aangeboren: n=116; verworven: n=90). Vervolgens werd er een afzonderlijke analyse uitgevoerd voor kinderen met en zonder ipsilaterale CAKUT.

Resultaten

Op een gemiddelde leeftijd van 9,5 (standaarddeviatie 5,6) jaar waren tekenen van nierschade aanwezig bij 32% van de kinderen met een mononier. Het bestaan van tekenen voor nierschade was niet afhankelijk van het type mononier. Kinderen met ipsilaterale CAKUT hadden vaker tekenen van nierschade dan kinderen zonder ipsilaterale CAKUT (48% vs. 25%; p=0,03).

Discussie

Het KIMONO-studiecohort toont aan dat een aanzienlijk deel van de kinderen op jonge leeftijd één of meer tekenen heeft van nierschade. Deze resultaten suggereren een belangrijk risico op chronische nierinsufficiëntie op latere leeftijd. Het risico is extra duidelijk wanneer er CAKUT aanwezig is aan de zijde van de mononier. Wij benadrukken daarom de noodzaak tot poliklinisch vervolg van alle kinderen met een mononier.

Summary

Introduction

Children with a solitary functioning kidney (SFK) have a potential risk of developing hypertension, (micro)albuminuria and chronic kidney disease. This might be caused by glomerular hyperfiltration and the high incidence of congenital anomalies of the kidney and urinary tract (CAKUT). The KIMONO-study determines the incidence of renal injury in a large cohort of children with an SFK.

Methods

Markers for renal injury (hypertension, (micro)albuminuria and chronic kidney disease) were retrospectively evaluated in 206 children with different types of SFK (congenital: n=116; acquired: n=90). Additionally, children with ipsilateral CAKUT were stratified and analyzed separately.

Results

Renal injury occurred in 32% of the children with an SFK at a mean age of 9.5 (standard deviation 5.6) years. The incidence of renal injury was independent from SFK-type. Children with ipsilateral CAKUT more frequently showed renal injury than children without CAKUT (48% vs. 25%; p=0.03).

Discussion

The KIMONY-study cohort demonstrates that a substantial sample of children with an SFK show signs of renal injury at a young age. These results imply an important risk for chronic kidney disease in later life, which is even more pronounced in children with additional ipsilateral CAKUT.We therefore underline the need for clinical follow-up of this specific patient group.

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Authors and Affiliations

  1. afdeling Kindernefrologie, VU medisch centrum, PK 4 X 033, Postbus, 7057, 1007, MB, Amsterdam, The Netherlands

    Rik Westland,  Arend Bökenkamp &  Joanna A.E. van Wijk

  2. afdeling Kindernefrologie, UMC St Radboud, Nijmegen, The Netherlands

    Michiel F. Schreuder

  3. afdeling Klinische Epidemiologie en Biostatistiek, VU medisch centrum, Amsterdam, The Netherlands

    Marieke D. Spreeuwenberg

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  1. Rik Westland
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  2. Arend Bökenkamp
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  3. Joanna A.E. van Wijk
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  4. Michiel F. Schreuder
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  5. Marieke D. Spreeuwenberg
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Correspondence to Rik Westland.

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Alle auteurs verklaren geen conflicterende belangen te hebben.

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Westland, R., Bökenkamp, A., van Wijk, J. et al. Nierschade bij kinderen met een mononier. TIJDSCHR. KINDERGENEESKUNDE 80, 129–136 (2012). https://doi.org/10.1007/s12456-012-0037-z

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