In-vivo techniques for determining nephron number

Aleksandar Denic, Hisham Elsherbiny, Andrew D Rule

Research output: Contribution to journalArticle

Abstract

Purpose of review Many studies have suggested low nephron endowment at birth contributes to the risk of developing hypertension and chronic kidney disease (CKD) later in life. Loss of nephrons with age and disease is largely a subclinical process. New technologies are needed to count nephrons as glomerular filtration rate (GFR) is a poor surrogate for nephron number. Recent findings Cortical volume, glomerular density, and percent globally sclerotic glomeruli are imperfect surrogates for nephron number. The disector-fractionator method is the most accurate method to count nephrons but is limited to autopsy settings. Glomerular density combined with kidney imaging and ultrafiltration coefficient-based methods require a kidney biopsy, and have been applied in living humans (kidney donors). Low nephron number predicts a higher postdonation urine albumin. Contrast-enhanced MRI has detected glomeruli without a biopsy, but so far, not in living humans. Summary Currently, there is no accurate and well tolerated method for determining nephron number in living humans. A clinically useful method may allow GFR to be replaced by its more relevant determinants: nephron number and single nephron GFR. This could revolutionize nephrology by separating the measurement of chronic disease (nephron loss) from more reversible hemodynamic effects (nephron hyperfiltration/hypofiltration).

Original languageEnglish (US)
JournalCurrent opinion in nephrology and hypertension
DOIs
StateAccepted/In press - Jan 1 2019

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Nephrons
Glomerular Filtration Rate
Kidney
Biopsy
Nephrology
Ultrafiltration
Financial Management
Chronic Renal Insufficiency
Albumins
Autopsy
Chronic Disease
Hemodynamics
Urine
Parturition
Hypertension
Technology

Keywords

  • glomerular density
  • glomeruli
  • kidney biopsy
  • kidney volume
  • MRI
  • nephron number

ASJC Scopus subject areas

  • Internal Medicine
  • Nephrology

Cite this

In-vivo techniques for determining nephron number. / Denic, Aleksandar; Elsherbiny, Hisham; Rule, Andrew D.

In: Current opinion in nephrology and hypertension, 01.01.2019.

Research output: Contribution to journalArticle

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