Early determination of renal injury in children with solitary functioning kidney

ABSTRACT Early Determination Of Renal Injury In Children With Solitary Functioning Kidney Aim: Unilateral renal agenesis; is a situation where the unilateral renal embryologic development is not formed and there is a solitary functional ectopic kidney on the contralateral side. Patients with congenital unilateral renal agenesis are at risk for developing proteinuria, hypertension and renal failure in their long-term follow-up. In this study we aimed to determine the renal injury before proceeded at early phase by using the new markers in children with solitary functioning kidney Materials and Methods: Forty-four patients, with an age of > 5 years, who were regularly followed up for unilateral renal agenesis in Çukurova University Balcalı Hospital Pediatric Nephrology Clinic between I January 2016 and 31 December 2017 dates and 43 healthy controls of similar age and sex without any disease were included in the study. It has been shown that there is no pathology with DMSA, USG and VCUG in the intact kidney of these patients. Patients and control groups were divided into 3 groups according to their age. Fourteen patients (32%) aged between 5-9 years in the first group, 17 patients (39%) aged between 10-14 years in the second group and 13 patients (29%) aged between 15-19 in the third group were included in patient group. In the healthy control group, there were 12 healthy children aged 5 to 9 years (28%) in the first group, 14 healthy children (33%) aged 10-14 years in the second group and 17 healthy children (39%) aged 15-19 years in the third group. Renal function tests were evaluated in patients and control groups. Microalbumin/creatinine nephelometric, NGAL/creatinine and interleukin 18/creatinine levels in urine were measured by ELISA method. Renal ultrasound kidney size was assessed according to the age-specific percentile chart. Results: There were no difference between patient and control groups in terms of renal function tests, renal size, mean blood pressures and urinary microalbumin/creatinine excretion. In patient group the median value of the NGAL/creatinine levels was 2,46-2.24 ng/mg and in the control group the median value of the NGAL/creatinine levels at the ages of 5-9 were 1,93-1,44 ng/mg. There was no statistical difference between patient and control groups in terms of urinal NGAL/cr findings (p=0,427).In patient group urinal IL-18/urinal creatinine median value was 0.30pg/mg at ages 5-9, 0,84 pg/mg at ages 10-14 and 21.13pg/mg at ages of 15-19. In the control group these median values were as follows; 0,33 pg/mg in group 1 at ages 5-9, 0,20 pg/mg in group 2 at ages 10-14 and 0,18 pg/mg in group 3 at ages 15-19. Urine IL-18/Cr ratio was statistically significantly different between patient and control groups with the median value of 17.70 in patient group and 2,79 in control group (p values were p = 0.014 and p = 0.002, respectively). Conclusion: The increase in urinary IL-18/urinary creatinine ratios, which is one of the early markers of renal damage, with the patient's age increase, can be regarded as an early indication that glomerular injury may begin in the second decatum in these children. Children born with congenital unilateral renal agenesis should be reminded that there is a risk of permanent renal damage due to glomerular hyperfiltration in the later stages of their life and the rate of permanent renal damage should be reduced with early diagnosis and treatment of the damage. Keywords: Unilateral renal agenesis, NGAL/Cr in urine, IL-18/Cr in urine, glomerular hyperfiltration