On 2014 Sep 01, Francois Cachat commented:

In this study, the authors demonstrated that the outcome of children with a single kidney is not as good as it was thought previously. As they pointed out rightfully, poor outcome (proteinuria, hypertension, chronic kidney disease (CKD)) is (mostly) related to the addition of other injury to the single kidney such as (recurrent) pyelonephritis or obstruction. That was the case in 4 of 5 patients they described with CKD. Genetics might play a role as well (as with their 5th patient with hypodysplasia). Other studies also reported chemotherapy after Wilms tumor and nephrectomy as a risk factor for poor outcome. In addition to CKD, it would be interesting to know if hypertension (3 patients) and proteinuria (2 patients) was found only in the "high risk" group of patients with a single kidney. It is my understanding that a child with a congenital single kidney, with no other anomalies, with renal length above 95th percentile, and no other aggression such as hypertension or diabetes, is probably not at higher risk than the general population of developping renal disease (but that remains to be demonstrated in long-term follow up cohort studies)(hyperfiltration might be deleterious as well on a long-term basis). Thank you and congratulation to the authors for their work.

On 2014 Sep 01, Francois Cachat commented:

In this study, the authors demonstrated that the outcome of children with a single kidney is not as good as it was thought previously. As they pointed out rightfully, poor outcome (proteinuria, hypertension, chronic kidney disease (CKD)) is (mostly) related to the addition of other injury to the single kidney such as (recurrent) pyelonephritis or obstruction. That was the case in 4 of 5 patients they described with CKD. Genetics might play a role as well (as with their 5th patient with hypodysplasia). Other studies also reported chemotherapy after Wilms tumor and nephrectomy as a risk factor for poor outcome. In addition to CKD, it would be interesting to know if hypertension (3 patients) and proteinuria (2 patients) was found only in the "high risk" group of patients with a single kidney. It is my understanding that a child with a congenital single kidney, with no other anomalies, with renal length above 95th percentile, and no other aggression such as hypertension or diabetes, is probably not at higher risk than the general population of developping renal disease (but that remains to be demonstrated in long-term follow up cohort studies)(hyperfiltration might be deleterious as well on a long-term basis). Thank you and congratulation to the authors for their work.