Background

Having a low nephron number is a well-known risk factor for hypertension. There is an inverse relationship between the filtration surface area and systemic hypertension. A significant percentage of masked hypertension can be detected in children with nephron loss by ambulatory blood pressure monitoring (ABPM).

Methods

We prospectively investigated ABPM results of children having reduced kidney mass with normal office blood pressures (BPs) and kidney function. Forty-three children with congenital solitary kidney (group 1), 11 children with acquired solitary kidney (group 2), and 76 children with hypofunctioning kidney (group 3) were compared with age, gender, and BMI-matched healthy control group (group 4). The dietary salt intake of 76 patients was evaluated as salt equivalent (g/day). The primary endpoint was change from baseline in mean 24-h ABPM variables and the proportion of patients with masked hypertension when assessed by ABPM.

Results

The masked hypertension ratio of all patients was 12.3% when assessed with ABPM. Night hypertension was significantly higher in all patient groups than in the control group (p = 0.01). Diastolic BP loads of groups 1 and 3 were higher than in controls (p = 0.024). Systolic BP loads were higher only in group 1 than in the control group (p = 0.003). The dietary salt equivalent of patients in group 1 correlated positively with 24-h SBP and mean arterial pressure (MAP) values. Patients with excessive dietary salt intake in group 1 had a significantly higher diastolic BP load than those without excessive salt intake in group 1 (p = 0.002).

Conclusions

Masked hypertension can be seen in children with a solitary kidney or when one of the kidneys is hypofunctioning. Systolic BP loads are higher in children with congenital solitary kidney, and salt intake correlates with systolic BP profiles especially in those. Our results suggest that being born with a congenital solitary kidney increases predisposition to hypertension and salt sensitivity.

Graphical abstract

中文翻译：

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单肾或肾功能低下的儿童患隐匿性高血压的患病率是否相同？

背景

肾单位数低是众所周知的高血压危险因素。滤过表面积与全身性高血压呈反比关系。动态血压监测 (ABPM) 可在肾单位丢失的儿童中检测到相当大比例的隐匿性高血压。

方法

我们前瞻性地调查了在诊室血压 (BP) 和肾功能正常的情况下肾脏质量减少的儿童的 ABPM 结果。将 43 名先天性孤立肾患儿（第 1 组）、11 名获得性孤立肾患儿（第 2 组）和 76 名肾功能减退患儿（第 3 组）与年龄、性别和 BMI 匹配的健康对照组（组4）。76 名患者的膳食盐摄入量被评估为盐当量（g/天）。主要终点是平均 24 小时 ABPM 变量和通过 ABPM 评估的隐匿性高血压患者的比例相对于基线的变化。

结果

用 ABPM 评估所有患者的隐匿性高血压比率为 12.3%。所有患者组的夜间高血压均显着高于对照组（p = 0.01）。第 1 组和第 3 组的舒张压负荷高于对照组 ( p = 0.024)。只有第 1 组的收缩压负荷高于对照组（p = 0.003）。第 1 组患者的膳食盐当量与 24 小时 SBP 和平均动脉压 (MAP) 值呈正相关。第 1 组饮食盐摄入过多的患者舒张压负荷显着高于第 1 组未摄入过多盐的患者（p = 0.002）。

结论

隐匿性高血压可见于单肾或其中一个肾功能减退的儿童。先天性孤立肾患儿的收缩压负荷较高，盐摄入量与收缩压曲线相关，尤其是在这些患儿中。我们的研究结果表明，先天性孤立肾会增加患高血压和盐敏感性的倾向。

图形概要