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Open Access 01-07-2012 | Original Article

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

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

Published in: Pediatric Nephrology | Issue 7/2012

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 cystinosis, 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 nephrectomy (p = 0.005). 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 hypoperfusion and its postulated consequences for graft outcome.

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Title: Native nephrectomy prior to pediatric kidney transplantation: biological and clinical aspects
Authors: Fatemeh Ghane Sharbaf
Martin Bitzan
Konrad M. Szymanski
Lorraine E. Bell
Indra Gupta
Jean Tchervenkov
John-Paul Capolicchio
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Pediatric Nephrology / Issue 7/2012
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-012-2115-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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