How effective is nephrectomy in curing hypertension in children with unilateral poorly functioning kidney? A systematic review
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In brief
In brief
This systematic review examines whether removing a poorly functioning kidney can cure hypertension in children, analyzing 88 pediatric cases. Nephrectomy successfully resolved hypertension in approximately two-thirds of children, with vesicoureteral reflux being the most common underlying cause.
- Nephrectomy cures hypertension in 65.9% of children with unilateral poorly functioning kidney, avoiding long-term antihypertensive medication.
- Unilateral atrophic kidney with/without VUR accounts for 43% of PFK cases causing pediatric hypertension.
- Laparoscopic nephrectomy is increasingly utilized and may be first-line surgical approach for PFK-related hypertension in children.
- Follow-up of 1.5-3.3 years demonstrates sustained blood pressure control in two-thirds of children post-nephrectomy.
- Renovascular pathology accounts for 22% of PFK cases; UPJ obstruction and MCDK together represent 35% of etiologies.
Written by the GCMD Library team from the article.
Abstract
Purpose
Some children with hypertension (HTN) have unilateral poorly functional kidney (PFK). This provides an opportunity for the clinician to cure the HTN by removal of the PFK, thereby avoiding the problems of long-term medication. However, there is sparse data in children regarding the effect of PFK nephrectomy on curing HTN. In this review, we analysed the etiology of PFK causing HTN and the effectiveness of nephrectomy in curing HTN in children.
Methods
We searched the databases to identify papers between January 2000 to December 2020 pertaining to children with PFK and HTN who underwent nephrectomy. Outcome analyzed was the resolution of HTN following nephrectomy. Duplicate publications, review articles and incomplete articles were excluded. Meta-analysis of heterogeneity was reported with I2statistics. Forest plot was constructed to compare the pooled prevalence of HTN resolution.
Results
Five articles with 88 patients were included. Majority (43%) of PFK were due to the unilateral atrophic kidney with or without vesicoureteral reflux (VUR); ureteropelvic junction obstruction and multicystic dysplastic kidney together accounted for 35% of cases and renovascular pathology for 22% of cases. With a follow-up of 1.5 to 3.3 years, nephrectomy was effective to cure HTN in 65.9% (95% CI 55–75%) children.
Conclusions
In children with HTN and a unilateral PFK, nephrectomy cured the HTN in two-thirds of children. Unilateral atrophic kidney due to VUR was the most common cause of PFK. An increase in the utilisation of laparoscopy was observed in recent publications, hence laparoscopic nephrectomy may be considered a first choice of treatment in these children.