Mary Katie Wang1, Thomas Gaither1, Andrew Phelps2, Ronald Cohen3, Laurence Baskin4. 1. UCSF Benioff Children's Hospital, Department of Urology, Division of Pediatric Urology, San Francisco, CA. 2. UCSF Benioff Children's Hospital, Department of Radiology and Biomedical Imaging, San Francisco, CA. 3. UCSF Benioff Children's Hospital Oakland, Department of Radiology, Oakland, CA. 4. UCSF Benioff Children's Hospital, Department of Urology, Division of Pediatric Urology, San Francisco, CA. Electronic address: Laurence.baskin@ucsf.edu.
Abstract
OBJECTIVE: To evaluate the incidence and durability of compensatory hypertrophy with solitary kidneys in the setting of those with multicystic dysplastic kidney (MCDK) or Wilms tumor (WT) status postnephrectomy. PATIENTS AND METHODS: We conducted a retrospective cohort study of patients with MCDK and WT. MCDK patients were verified by sonographic findings prenatally. WT patients entered our study at time of nephrectomy. We compared the natural history of hypertrophy between the 2 cohorts via renal length measurement. We performed linear regression to predict creatinine clearance from renal length after adjusting for age and cohort status (MCDK versus WT). RESULTS: Fifty-two patients (56%) were diagnosed with WT, and 71 patients (44%) with MCDK patients met study criteria with a median age of postnatal ultrasound at 1.6 months (interquartile range 0.5-3.6). The median (IQR) follow-up time was 7.5 years. At the time of nephrectomy, 25/52 (48%) of Wilms patients had contralateral hypertrophy, while at diagnosis 22/71 (31%) of MCDK patients had contralateral hypertrophy, P = .03. Contralateral hypertrophy was a consistent finding throughout follow-up. As renal length increases by 1 cm, glomerular filtration rate increased by 7.8 mL/min/m2 (95% confidence interval 1.8-13.8, P = .01). CONCLUSION: Contralateral hypertrophy appears to be a compensatory mechanism for unilateral kidney pathology as demonstrated by MCDK and WT patients. Hypertrophy often occurs at the time of diagnosis and appears to be a permanent finding as children reach their teenage years. Additionally, in nonhydronephrotic kidneys, increases in renal length correlate with improvement in glomerular filtration rate. Overall, the majority of children with solitary kidneys demonstrate compensatory hypertrophy.
OBJECTIVE: To evaluate the incidence and durability of compensatory hypertrophy with solitary kidneys in the setting of those with multicystic dysplastic kidney (MCDK) or Wilms tumor (WT) status postnephrectomy. PATIENTS AND METHODS: We conducted a retrospective cohort study of patients with MCDK and WT. MCDK patients were verified by sonographic findings prenatally. WT patients entered our study at time of nephrectomy. We compared the natural history of hypertrophy between the 2 cohorts via renal length measurement. We performed linear regression to predict creatinine clearance from renal length after adjusting for age and cohort status (MCDK versus WT). RESULTS: Fifty-two patients (56%) were diagnosed with WT, and 71 patients (44%) with MCDK patients met study criteria with a median age of postnatal ultrasound at 1.6 months (interquartile range 0.5-3.6). The median (IQR) follow-up time was 7.5 years. At the time of nephrectomy, 25/52 (48%) of Wilmspatients had contralateral hypertrophy, while at diagnosis 22/71 (31%) of MCDK patients had contralateral hypertrophy, P = .03. Contralateral hypertrophy was a consistent finding throughout follow-up. As renal length increases by 1 cm, glomerular filtration rate increased by 7.8 mL/min/m2 (95% confidence interval 1.8-13.8, P = .01). CONCLUSION:Contralateral hypertrophy appears to be a compensatory mechanism for unilateral kidney pathology as demonstrated by MCDK and WT patients. Hypertrophy often occurs at the time of diagnosis and appears to be a permanent finding as children reach their teenage years. Additionally, in nonhydronephrotic kidneys, increases in renal length correlate with improvement in glomerular filtration rate. Overall, the majority of children with solitary kidneys demonstrate compensatory hypertrophy.
Authors: Sander Groen In 't Woud; Nieke Reuver; Wout F J Feitz; Josine S L T Quaedackers; Rien Nijman; Martijn Steffens; Liesbeth L L de Wall; Nel Roeleveld; Michiel F Schreuder; Loes F M van der Zanden Journal: Eur Urol Open Sci Date: 2021-10-27
Authors: Sander Groen In 't Woud; Rik Westland; Wout F J Feitz; Nel Roeleveld; Joanna A E van Wijk; Loes F M van der Zanden; Michiel F Schreuder Journal: Eur Urol Open Sci Date: 2021-02-03