# Total Kidney Volume, Hypertension, and Deterioration of Kidney Function in Children with Early-Stage ADPKD

## TL;DR

This study shows that kidney volume and blood pressure are linked to kidney function decline in children with early-stage ADPKD.

## Contribution

The study identifies the predictive value of TKV z-score for GFR decline in children with ADPKD.

## Key findings

- Hypertension was found in 28% of children with early-stage ADPKD.
- Higher TKV z-scores correlated with greater GFR decline and were useful for predicting it.
- TKV z-scores showed strong correlation with blood pressure parameters but not for predicting hypertension onset.

## Abstract

Background: Several studies have shown that total kidney volume (TKV) measurements may serve as a non-invasive imaging biomarker for monitoring and predicting the progression of autosomal dominant polycystic kidney disease (ADPKD) in children. Methods: This study aimed to evaluate the relationship between height-adjusted TKV (htTKV), estimated glomerular filtration rate (GFR), and blood pressure, assessed using 24 h ambulatory blood pressure monitoring (ABPM), in children with early-stage ADPKD. The study was conducted with 72 children, mean age 12.46 ± 3.76 (5.42–17.92). Results: Hypertension (HT) was diagnosed in (20) 28% of children. ABPM allowed the identification of previously undiagnosed HT in 12 (16.7%) children. Decreased GFR was demonstrated in 10 (14%) children, and hyperfiltration in 5 (7%) children. Significantly higher htTKV and calculated TKV z-score and more frequent decreases in GFR were observed in hypertensive children (p = 0.018; 0.020 and 0.010, respectively). The study demonstrated a significant inverse correlation between htTKV and GFR (r −0.25; p = 0.032). The TKV z-score showed a very good correlation with all ABPM parameters, except for DBP and DBP z-score during the day. Receiver operating curve (ROC) analysis showed that htTKV and TKV z-score had good diagnostic value for predicting a decline in GFR (AUC 0.808, p < 0.001), but were not useful for predicting the onset of HT (AUC 0.697, p = 0.010). Conclusions: There is a relationship between TKV, GFR, and blood pressure parameters in children with early-stage ADPKD. The TKV z-score can be useful for predicting GFR decline. Children with ADPKD and increasing TKV require careful blood pressure monitoring.