Close
Enter your
text here

Treating Severe Pediatric Kidney Disease with Simultaneous Bilateral Native Nephrectomy

Treating Severe Pediatric Kidney Disease with Simultaneous Bilateral Native Nephrectomy 480 320 Abbie Miller

A 15-year review of indications, approaches and outcomes

A recent study published in Pediatric Transplantation and led by Christina B. Ching, MD, pediatric urologist in the Department of Pediatric Urology at Nationwide Children’s Hospital, offers valuable insights into a very rare clinical procedure: simultaneous bilateral native nephrectomies, or the removal of both kidneys at the same time, in children.[1]

This retrospective chart review spans 15 years and represents one of the largest single-center cohorts. It evaluates the indications, approaches and outcomes of simultaneous bilateral native nephrectomies in a pediatric population.

“While the clinical need for this procedure is rare, I recently participated in two at Nationwide Children’s,” says Dr. Ching. “When reviewing what data exists about this intervention, my search led me to see this as a clear opportunity to add to the limited literature, particularly in pediatrics.”

The study included ten patients under 21 years of age who underwent simultaneous bilateral native nephrectomies between January 2009 and August 2024. The mean age was 9.6 years. Each patient initially presented with a severe clinical picture that was thought to be related to their native kidneys, such as hypertensive crisis or nephrotic syndrome, requiring urgent inpatient intervention.

“We found simultaneous bilateral nephrectomy is often a result of significant clinical need,” Dr. Ching emphasizes. “In each case, the native kidneys were causing more harm than good and were actually worsening the medical outcome.”

Before the procedure, six patients were on hemodialysis, two were receiving peritoneal dialysis, and two were not yet on any form of renal replacement therapy. Significantly, the procedure did not interrupt ongoing dialysis protocols. Both peritoneal dialysis patients resumed therapy the next day following open retroperitoneal surgery, which was intentionally chosen to preserve this form of renal replacement therapy.

“The surgeries did not negatively impact the patients’ continuity of prior dialysis method,” Dr. Ching adds. “That was an important reassurance to the medical providers caring for these patients when weighing the risks of this procedure.”

Three of the ten surgeries were performed using a minimally invasive robot and seven via open approaches.

“While the number of patients receiving robotic surgery is too small for statistical comparison to an open approach, we found we could perform simultaneous bilateral robotic nephrectomies safely and that patients recovered well,” Dr. Ching explains.

Only one surgical complication occurred: a patient with recurrent urinary tract infections developed an intra-abdominal abscess. Clinicians managed it with percutaneous drainage.

Some controversy exists around the timing of nephrectomy relative to transplant. This study shows that simultaneous bilateral nephrectomy can be safe. It may even be necessary when the native kidneys harm a patient’s health.

“Our data show that, whether performed openly or robotically, simultaneous bilateral nephrectomy can be a viable option for children with complex end-stage renal disease,” Dr. Ching says.

Reference:

[1] Lombardo AM, Stout M, Zann A, et al. Simultaneous Bilateral Pediatric Nephrectomies: Indications, Approach and Outcomes Over a 15-Year Period. Pediatric Transplantation. 2025;29(3):e70072. doi:10.1111/petr.70072

 

About the author

Abbie (Roth) Miller, MWC, is a passionate communicator of science. As the manager, medical and science content, at Nationwide Children’s Hospital, she shares stories about innovative research and discovery with audiences ranging from parents to preeminent researchers and leaders. Before coming to Nationwide Children’s, Abbie used her communication skills to engage audiences with a wide variety of science topics. She is a Medical Writer Certified®, credentialed by the American Medical Writers Association.

You might also like