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

Fatemeh Ghane Sharbaf, Martin Bitzan, Konrad M. Szymanski, Lorraine E. Bell, Indra Gupta, Jean Tchervenkov, John Paul Capolicchio

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1179-1188
Number of pages10
JournalPediatric Nephrology
Volume27
Issue number7
DOIs
StatePublished - Jul 1 2012
Externally publishedYes

Keywords

  • CAKUT
  • Cystinosis
  • Nephrotic syndrome
  • Peritoneal dialysis
  • Polyuria
  • Proteinuria
  • Retroperitoneoscopic nephrectomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

Fingerprint Dive into the research topics of 'Native nephrectomy prior to pediatric kidney transplantation: Biological and clinical aspects'. Together they form a unique fingerprint.

  • Cite this

    Sharbaf, F. G., Bitzan, M., Szymanski, K. M., Bell, L. E., Gupta, I., Tchervenkov, J., & Capolicchio, J. P. (2012). Native nephrectomy prior to pediatric kidney transplantation: Biological and clinical aspects. Pediatric Nephrology, 27(7), 1179-1188. https://doi.org/10.1007/s00467-012-2115-y