Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis among Apparently Healthy Adults

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Abstract

Background: Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear. Study Design: Cross-sectional (clinical-pathologic correlation). Setting & Participants: Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011. Predictors Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness. Outcomes: Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation. Results: Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis. Limitations: Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings. Conclusions: Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.

Original languageEnglish (US)
Pages (from-to)58-67
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume68
Issue number1
DOIs
StatePublished - Jul 1 2016

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Nephrosclerosis
Nephrons
Hypertrophy
Kidney
Living Donors
Hypertension
Cysts
Biopsy
Kidney Cortex
Clinical Pathology
Arteriosclerosis
Uric Acid
Glomerular Filtration Rate
Chronic Kidney Failure
Atrophy
Albumins
Body Mass Index
Fibrosis

Keywords

  • aging
  • arteriosclerosis
  • biopsy
  • chronic kidney disease (CKD) risk factor
  • contrast computed tomographic (CT) scan
  • high-resolution imaging
  • hypertension
  • kidney function
  • kidney macrostructure
  • kidney microstructure
  • kidney volume
  • living kidney donor
  • nephron hypertrophy
  • Nephrosclerosis
  • subclinical renal pathology

ASJC Scopus subject areas

  • Nephrology

Cite this

@article{5db60fbf909349b4a59413d414deb4ab,
title = "Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis among Apparently Healthy Adults",
abstract = "Background: Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear. Study Design: Cross-sectional (clinical-pathologic correlation). Setting & Participants: Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011. Predictors Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness. Outcomes: Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation. Results: Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis. Limitations: Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings. Conclusions: Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.",
keywords = "aging, arteriosclerosis, biopsy, chronic kidney disease (CKD) risk factor, contrast computed tomographic (CT) scan, high-resolution imaging, hypertension, kidney function, kidney macrostructure, kidney microstructure, kidney volume, living kidney donor, nephron hypertrophy, Nephrosclerosis, subclinical renal pathology",
author = "Aleksandar Denic and Alexander, {Mariam P} and Vidhu Kaushik and Lerman, {Lilach O} and Lieske, {John C} and Stegall, {Mark D} and Larson, {Joseph J.} and Kremers, {Walter K} and Vrtiska, {Terri J} and Chakkera, {Harini M} and Poggio, {Emilio D.} and Rule, {Andrew D}",
year = "2016",
month = "7",
day = "1",
doi = "10.1053/j.ajkd.2015.12.029",
language = "English (US)",
volume = "68",
pages = "58--67",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "1",

}

TY - JOUR

T1 - Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis among Apparently Healthy Adults

AU - Denic, Aleksandar

AU - Alexander, Mariam P

AU - Kaushik, Vidhu

AU - Lerman, Lilach O

AU - Lieske, John C

AU - Stegall, Mark D

AU - Larson, Joseph J.

AU - Kremers, Walter K

AU - Vrtiska, Terri J

AU - Chakkera, Harini M

AU - Poggio, Emilio D.

AU - Rule, Andrew D

PY - 2016/7/1

Y1 - 2016/7/1

N2 - Background: Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear. Study Design: Cross-sectional (clinical-pathologic correlation). Setting & Participants: Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011. Predictors Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness. Outcomes: Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation. Results: Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis. Limitations: Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings. Conclusions: Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.

AB - Background: Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear. Study Design: Cross-sectional (clinical-pathologic correlation). Setting & Participants: Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011. Predictors Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness. Outcomes: Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation. Results: Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis. Limitations: Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings. Conclusions: Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.

KW - aging

KW - arteriosclerosis

KW - biopsy

KW - chronic kidney disease (CKD) risk factor

KW - contrast computed tomographic (CT) scan

KW - high-resolution imaging

KW - hypertension

KW - kidney function

KW - kidney macrostructure

KW - kidney microstructure

KW - kidney volume

KW - living kidney donor

KW - nephron hypertrophy

KW - Nephrosclerosis

KW - subclinical renal pathology

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U2 - 10.1053/j.ajkd.2015.12.029

DO - 10.1053/j.ajkd.2015.12.029

M3 - Article

C2 - 26857648

AN - SCOPUS:84975175121

VL - 68

SP - 58

EP - 67

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 1

ER -