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Larger nephron size, low nephron number, and nephrosclerosis on biopsy as predictors of kidney function after donating a kidney
Author(s) -
Issa Naim,
Vaughan Lisa E.,
Denic Aleksandar,
Kremers Walter K.,
Chakkera Harini A.,
Park Walter D.,
Matas Arthur J.,
Taler Sandra J.,
Stegall Mark D.,
Augustine Joshua J.,
Rule Andrew D.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15259
Subject(s) - medicine , nephron , renal function , kidney , urology , endocrinology , nephrosclerosis , proteinuria , glomerulosclerosis , creatinine
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 m 2 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 m 2 . 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 m 2 , modest increases in urine albumin, and hypertension shortly after kidney donation.