Native nephrectomy prior to pediatric kidney transplantation: Biological and clinical aspects

Sharbaf, F. G. and Bitzan, M. and Szymanski, K. M. and Bell, L. E. and Gupta, I. and Tchervenkov, J. and Capolicchio, J. P. (2012) Native nephrectomy prior to pediatric kidney transplantation: Biological and clinical aspects. Pediatric Nephrology, 27 (7). pp. 1179-1188.

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Background Pre-transplant nephrectomy is performed to reduce risks to graft and recipient. The aims of this study were to evaluate (1) indications, surgical approach, and morbidity of native nephrectomy and (2) the effects of kidney removal on clinical and biological parameters. Methods This study was designed as a single-center retrospective cohort study in which 49 consecutive patients with uni- or bilateral native nephrectomies were identified from a total of 126 consecutive graft recipients in our pediatric kidney transplantation database between 1992 and 2011. Demographic, clinical, and laboratory details were extracted from charts and electronic records, including operation reports and pre- and post-operative clinic notes. Results Of the 49 nephrectomized patients, 47 had anomalies of the kidneys and urinary tract, 22 had cysti-nosis, 12 had focal segmental glomerulosclerosis, and 6 had congenital nephrotic syndrome. Nephrectomy decisions were based on clinical judgment, taking physiological and psychosocial aspects into consideration. Nephrectomy was performed in patients with polyuria (>2.5 ml/kg/h) and/or large proteinuria (>40 mg/m2/h), recurrent urinary tract infection or (rarely) hypertension. Urine output decreased from (median) 3.79 to 2.32 ml/kg/h (-34), and proteinuria from 157 to 100 mg/m2/h (-40) after unilateral nephrec-tomy (p00.005). After bilateral nephrectomy, serum albumin, protein and fibrinogen concentrations normalized in 93, 73, and 55 of nephrectomized patients, respectively. Clinically relevant procedure-related complications (peritoneal laceration, hematoma) occurred in five patients. Conclusion In summary, we demonstrate quantitatively that native nephrectomy prior to transplantation improved serum protein levels and anticipated post-transplant fluid intake needs in select children, reducing the risk of graft hypoper-fusion and its postulated consequences for graft outcome. © 2011 IPNA.

Item Type: Article
Additional Information: Cited By :19 Export Date: 16 February 2020 CODEN: PEDNE Correspondence Address: Bitzan, M.; Division of Nephrology, Montreal Children's Hospital, McGill University, 2300, rue Tupper-E222, Montreal, QC H3H 1P3, Canada; email:
Uncontrolled Keywords: CAKUT Cystinosis Nephrotic syndrome Peritoneal dialysis Polyuria Proteinuria Retroperitoneoscopic nephrectomy albumin fibrinogen protein adolescent adult article Bartter syndrome child clinical article concentration (parameters) congenital anomalies of kidney and urinary tract congenital nephrotic syndrome Denys Drash syndrome focal glomerulosclerosis graft recipient hematoma hemodialysis histopathology human hypertension interstitial nephritis kidney disease kidney dysplasia kidney failure kidney polycystic disease kidney transplantation laceration nephrectomy pediatric surgery peritoneal laceration postoperative complication priority journal recurrent infection surgical technique treatment indication urinary tract disease urinary tract infection urine volume Child, Preschool Cohort Studies Humans Kidney Kidney Failure, Chronic Retrospective Studies Treatment Outcome Young Adult
Subjects: WJ Urogenital System
WS Pediatrics
Divisions: Mashhad University of Medical Sciences
Depositing User: mr lib5 lib5
Date Deposited: 08 Apr 2020 05:43
Last Modified: 08 Apr 2020 05:43

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