Pediatric biopsy of a single native kidney

Blood pressure, renal function, and proteinuria in children with unilateral renal agenesis

BACKGROUND/AIM

Unilateral renal agenesis (URA) is a model for a reduced nephron number that is believed to be a risk factor for blood pressure (BP) elevation and reduced renal function. The aim of the study was to investigate BP and renal function in children with URA.

METHODS

Data on children with URA from two pediatric nephrology centers were firstly retrospectively reviewed (renal ultrasound and scintigraphy, clinical BP, creatinine clearance, urinalysis). Children with normal renal ultrasound and scintigraphy were thereafter investigated using ambulatory BP monitoring.

RESULTS

Twenty-nine children with URA were investigated--14 children with an abnormal kidney (mostly scarring) and 15 children with healthy kidneys. Hypertension was diagnosed on the basis of clinical BP in 57% of the children with abnormal kidneys and on the basis of ambulatory BP monitoring in 1 child (7%) with healthy kidneys. The mean ambulatory BP in children with normal kidneys was not significantly different from that in controls. Forty-three percent of the children with abnormal kidneys had a reduced renal function, but none of children with normal kidneys.

CONCLUSIONS

Children with abnormalities of a solitary kidney have often hypertension, proteinuria, or a reduced renal function. In contrast, children with healthy solitary kidneys have BP and renal function similar to those of healthy children.

Percutaneous renal biopsy

Percutaneous renal biopsy (PRB) is an integral part of the clinical practice of nephrology. It is essential in the diagnosis of glomerular, vascular, and tubulointerstitial diseases of the kidney, providing information that is invaluable in prognosis and patient management. The use of real-time ultrasound and automated biopsy needles has simplified and improved the success and safety of this procedure. In the recent past, we have seen a shift of the PRB from nephrologists to radiologists and this has raised appropriate concern that loss of this procedure may undermine the nephrologist's status as a subspecialist. We must continue to properly train young nephrologists in the proper technique and value of performing renal biopsy procedures or we stand to lose control of a procedure that was an integral part of the development of our subspecialty.