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. 2021 Sep;36(9):2837-2845.
doi: 10.1007/s00467-021-04980-6. Epub 2021 Feb 22.

Is the prognosis of congenital single functioning kidney benign? A population-based study

Hadas Alfandary  1   2 , Orly Haskin  3   4 , Ori Goldberg  4   5 , Amit Dagan  3   4 , Yael Borovitz  3   4 , Shelly Levi  3   4 , Miriam Davidovits  3   4 , Tomer Erlich  4   6   7 , Daniel Landau  3   4 , Oren Pleniceanu  4   6   8
Affiliations

Is the prognosis of congenital single functioning kidney benign? A population-based study

Hadas Alfandary et al. Pediatr Nephrol. 2021 Sep.

Abstract

Background: We investigated the risk of kidney injury among adolescents with and without a congenital single functioning kidney (SFK).

Methods: This retrospective study is based on a medical evaluation database of 17-year-old Israeli conscripts, born during 1989-1999. Those with congenital SFK diagnosis, verified by a pediatric nephrologist's review of the original military medical committee classifications, were compared to the rest of the cohort. Kidney injury (KI) was defined as proteinuria, high blood pressure (BP), or estimated glomerular filtration rate (eGFR) < 90 ml/min/1.73 m2 prior to army recruitment. Risk factors for KI were examined using logistic regression.

Results: Of 979,630 screened candidates, 353 were diagnosed with SFK. The yearly incidence of SFK gradually increased in the first years of the study, reaching a plateau in 1995 (5.5 ± 1.2/10,000 births/year). The male to female ratio was 2.7:1. Concomitant genital malformations were documented in 5.5% of those with SFK. KI was more prevalent in the SFK than the control group (42.2% vs. 23.5%, p < 0.001). All three components of KI were more common in the SFK than the control group: high BP (31.7% vs. 23.1%, p < 0.001), proteinuria (18.2% vs. 0.4%, p < 0.001), and eGFR <90 ml/min/1.73m2 (12.0% vs 0.1%, p < 0.001). Multivariate analysis of the SFK group revealed associations of higher mean BMI, male sex, and smaller ultrasonographic kidney length with KI.

Conclusions: This large population-based study documents a significant risk for KI among adolescents with SFK. Obesity represents a major modifiable risk factor for KI, implicating the need for closer follow-up in this group during childhood.

Keywords: Hypertension; Kidney failure; Kidney injury; Proteinuria; Single kidney; Solitary kidney.

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