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.

中文翻译：

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肾切除术治疗单侧肾功能不良儿童高血压的效果如何？系统回顾

目的

一些高血压（HTN）儿童患有单侧肾功能不良（PFK）。这为临床医生提供了通过去除PFK来治愈HTN的机会，从而避免了长期用药的问题。然而，关于儿童 PFK 肾切除术对治疗高血压的效果的数据很少。在这篇综述中，我们分析了 PFK 引起高血压的病因以及肾切除术治疗儿童高血压的有效性。

方法

我们检索了数据库，找出 2000 年 1 月至 2020 年 12 月期间有关接受肾切除术的 PFK 和 HTN 儿童的论文。分析的结果是肾切除术后高血压的缓解。重复出版物、评论文章和不完整的文章被排除在外。 I ²统计数据报告了异质性的荟萃分析。构建森林图是为了比较 HTN 分辨率的汇总流行率。

结果

纳入了涉及 88 名患者的 5 篇文章。大部分 (43%) PFK 是由于单侧肾脏萎缩，伴或不伴膀胱输尿管反流 (VUR)；肾盂输尿管连接部梗阻和多囊性肾发育不良合计占病例的 35%，肾血管病理占病例的 22%。经过 1.5 至 3.3 年的随访，肾切除术可有效治愈 65.9%（95% CI 55-75%）儿童的高血压。

结论

在患有 HTN 和单侧 PFK 的儿童中，肾切除术治愈了三分之二儿童的 HTN。 VUR 导致的单侧肾萎缩是 PFK 的最常见原因。最近的出版物中观察到腹腔镜检查的使用有所增加，因此腹腔镜肾切除术可能被认为是这些儿童的首选治疗方法。