Abstract
Background
Although hypotension is a life-threatening complication of nephrectomy in children, risk factors for its development remain unknown. We evaluated the incidence, clinical course, and associated risk factors of pediatric post-nephrectomy hypotension in an observational study.
Methods
This retrospective observational study included the clinical data of children who underwent nephrectomy in our center between 2002 and 2020. Patients undergoing nephrectomy at kidney transplantation and those who developed hypotension before nephrectomy were excluded.
Results
The study included 55 nephrectomies in 51 patients, including 42 unilateral, 4 two-stage bilateral, and 5 simultaneous bilateral nephrectomies. The diagnoses were isolated Wilms tumor, neuroblastoma, congenital nephrotic syndrome, Denys-Drash syndrome, WAGR (Wilms tumor, aniridia, genitourinary malformations, and mental retardation) syndrome, and autosomal recessive polycystic kidney disease in 24, 10, 9, 6, 1, and 1 patient, respectively. Post-nephrectomy hypotension developed in 11 (20%) patients. Two patients (3.6%) had persistent hypotension; both had their kidneys resected, and one patient (1.8%) died. Male sex, kidney disease, resection of both kidneys, low estimated glomerular filtration rate, increased left ventricular posterior wall thickness in diastole, hypertension before nephrectomy, antihypertensive use, hyperreninemia, and hyperaldosteronism were significantly associated with post-nephrectomy hypotension. Multivariate logistic regression analysis revealed that hypertension before nephrectomy was the only significant risk factor for post-nephrectomy hypotension (P = 0.04).
Conclusions
Hypertension before nephrectomy is a significant risk factor for pediatric post-nephrectomy hypotension. Life-threatening hypotension, which might occur after bilateral nephrectomy in infants, should be considered, especially in children with higher risks.
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Change history
12 July 2021
A Correction to this paper has been published: https://doi.org/10.1007/s00467-021-05198-2
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Acknowledgments
The authors would like to thank Drs. China Nagano for conducting the genetic diagnoses, and Drs. Makiko Nakayama and Kazumoto Iijima for their overall contributions to the study. The authors would also like to thank the medical editors from the Division of Education for Clinical Research at the National Center for Child Health and Development for editing a draft of this manuscript.
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KNi drafted the manuscript, oversaw the data collection, and performed the data analysis. MO, MS, SI, YS, CK, and KNo edited and reviewed the manuscript. KK revised the manuscript. KM, KI, and SI revised the manuscript and oversaw the work. All authors contributed to the study conception and design and approve the final manuscript as submitted.
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The study was approved by the institutional ethics committee of the National Center for Child Health and Development (approval no. 2019-046).
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In agreement with the principles of the Declaration of Helsinki and the Ethical Guidelines for Medical and Health Research Involving Human Subjects of the Ministry of Health, Labor, and Welfare, Japan, informed consent was not required for participating in the study. For genetic analyses, informed consent was obtained from all patients or their parents/legal guardians.
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Consent for publication was waived in accordance with the guidelines.
Conflict of interest
All authors declare no conflicts of interest concerning the present study. Koichi Kamei has received research funding from the Terumo Foundation for Life Sciences and Arts, and donations from Ono Pharmaceutical Co., Ltd. Kenji Ishikura has received grants from Asahi Kasei Pharma Corporation, Chugai Pharmaceutical Co., Ltd., Novartis International AG, Zenyaku Kogyo Co., Ltd., Japan Blood Products Organization, Otsuka Pharmaceutical Co., Ltd., Teijin Pharma Limited, Shionogi Co., Ltd., Eisai Co., Ltd., Astellas Pharma Inc., and JCR Pharmaceuticals Co., Ltd., and lecture fees from Asahi Kasei Pharma Corporation, Chugai Pharmaceutical Co., Ltd., Novartis International AG, Zenyaku Kogyo Co. Ltd., Otsuka Pharmaceutical Co., Ltd., Alexion Pharmaceuticals Inc., and Pfizer Inc., and consultant fees from Alexion Pharmaceuticals Inc. and Vifor Pharma Management Ltd. Shuichi Ito has received employment from Teijin Pharma Ltd., Honoraria from Sanofi K.K., and research funding from Teijin Pharma Ltd. and Astellas Pharma Co., Ltd. The other authors have no potential conflicts of interest to disclose.
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The original online version of this article was revised: In Table 4 of this article, the data in column “P value”, row “Age at nephrectomy (year)” contained a typesetting mistake.
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Nishi, K., Kamei, K., Ogura, M. et al. Risk factors for post-nephrectomy hypotension in pediatric patients. Pediatr Nephrol 36, 3699–3709 (2021). https://doi.org/10.1007/s00467-021-05115-7
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DOI: https://doi.org/10.1007/s00467-021-05115-7