TY - JOUR
T1 - Larger nephron size, low nephron number, and nephrosclerosis on biopsy as predictors of kidney function after donating a kidney
AU - Issa, Naim
AU - Vaughan, Lisa E.
AU - Denic, Aleksandar
AU - Kremers, Walter K.
AU - Chakkera, Harini A.
AU - Park, Walter D.
AU - Matas, Arthur J.
AU - Taler, Sandra J.
AU - Stegall, Mark D.
AU - Augustine, Joshua J.
AU - Rule, Andrew D.
N1 - Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/7
Y1 - 2019/7
N2 - It is unclear whether structural findings in the kidneys of living kidney donors predict postdonation kidney function. We studied living kidney donors who had a kidney biopsy during donation. Nephron size was measured by glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area. Age-specific thresholds were defined for low nephron number (calculated from CT and biopsy measures) and nephrosclerosis (global glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis). These structural measures were assessed as predictors of postdonation measured GFR, 24-hour urine albumin, and hypertension. Analyses were adjusted for baseline age, gender, body mass index, systolic and diastolic blood pressure, hypertension, measured GFR, urine albumin, living related donor status, and time since donation. Of 2673 donors, 1334 returned for a follow-up visit at a median 4.4 months after donation, with measured GFR <60 mL/min/1.73 m2 in 34%, urine albumin >5 mg/24 h in 13%, and hypertension in 5.3%. Larger glomerular volume and interstitial fibrosis/tubular atrophy predicted follow-up measured GFR <60 mL/min/1.73 m2. Larger cortex volume per glomerulus and low nephron number predicted follow-up urine albumin >5 mg/24 h. Arteriosclerosis predicted hypertension. Microstructural findings predict GFR <60 mL/min/1.73 m2, modest increases in urine albumin, and hypertension shortly after kidney donation.
AB - It is unclear whether structural findings in the kidneys of living kidney donors predict postdonation kidney function. We studied living kidney donors who had a kidney biopsy during donation. Nephron size was measured by glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area. Age-specific thresholds were defined for low nephron number (calculated from CT and biopsy measures) and nephrosclerosis (global glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis). These structural measures were assessed as predictors of postdonation measured GFR, 24-hour urine albumin, and hypertension. Analyses were adjusted for baseline age, gender, body mass index, systolic and diastolic blood pressure, hypertension, measured GFR, urine albumin, living related donor status, and time since donation. Of 2673 donors, 1334 returned for a follow-up visit at a median 4.4 months after donation, with measured GFR <60 mL/min/1.73 m2 in 34%, urine albumin >5 mg/24 h in 13%, and hypertension in 5.3%. Larger glomerular volume and interstitial fibrosis/tubular atrophy predicted follow-up measured GFR <60 mL/min/1.73 m2. Larger cortex volume per glomerulus and low nephron number predicted follow-up urine albumin >5 mg/24 h. Arteriosclerosis predicted hypertension. Microstructural findings predict GFR <60 mL/min/1.73 m2, modest increases in urine albumin, and hypertension shortly after kidney donation.
KW - clinical research/practice
KW - donors and donation: donor follow-up
KW - glomerular filtration rate (GFR)
KW - hypertension/antihypertensives
KW - kidney transplantation/nephrology
KW - kidney transplantation: living donor
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U2 - 10.1111/ajt.15259
DO - 10.1111/ajt.15259
M3 - Article
C2 - 30629312
AN - SCOPUS:85060856902
SN - 1600-6135
VL - 19
SP - 1989
EP - 1998
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 7
ER -