Monitoring is key in infants born with one kidney.
MAUI, HAWAII -- In infants born with unilateral renal agenesis, where a single kidney is functioning, it's important to confirm that the good kidney is, in fact, functional, said Dr. Carl M. Grushkin, head of the division of nephrology at Childrens Hospital Los Angeles.
About 1 in 400 term infants are born with unilateral renal agenesis, but only some will be diagnosed with the abnormality. "'If the solitary kidney in an infant is normal, as it is in most cases, the absence of a kidney will usually be picked up only [with] in utero or neonatal ultrasounds," he said at a meeting sponsored by the University Childrens Medical Group and the American Academy of Pediatrics' California Chapter 2.
Over time, a single good kidney undergoes compensatory hypertrophy. "During the first couple of weeks of life, you want to get a creatinine [level]. It ought to be in the range of 0.3, 0.4, 0.5 mg/dL--if it's 0.8, 0.9, or 1.0 mg/dL ... you need to repeat [the measurement] fairly soon to determine whether there is [a problem]."
One should monitor the child's growth and, from time to time, the growth of the kidney. "As long as the baby is growing and appears healthy ... then maybe at a year of age, it's worth getting another ultrasound to be sure that the kidney is undergoing compensatory hypertrophy," he said, adding that if normal kidneys were 4.5-5 cm at birth, they should be 6-6.5 cm at 1 year of age, but a compensatorily hypertrophied kidney should be 6.5-7 cm.
Dr. Grushkin said that routine physical activity for the child is fine, but he discourages participation in contact sports.
He alerts parents of girls to the possibility of an episode of pyelonephritis. Urinary tract infection is more common in girls and if a girl gets pyelonephritis in a single kidney, "that's acute renal failure," he said.
BY CAROLYN SACHS
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|Title Annotation:||Clinical Rounds|
|Publication:||Family Practice News|
|Article Type:||Brief article|
|Date:||Oct 1, 2007|
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