BACKGROUND: Over 5,000 living kidney donor nephrectomies are performed annually in the US. While the physiological changes that occur early after nephrectomy are well documented, less is known about the long-term glomerular dynamics in living donors. METHODS: We enrolled 21 adult living kidney donors to undergo detailed long-term clinical, physiological, and radiological evaluation pre-, early post- (median, 0.8 years), and late post- (median, 6.3 years) donation. A morphometric analysis of glomeruli obtained during nephrectomy was performed in 19 subjects. RESULTS: Donors showed parallel increases in single-kidney renal plasma flow (RPF), renocortical volume, and glomerular filtration rate (GFR) early after the procedure, and these changes were sustained through to the late post-donation period. We used mathematical modeling to estimate the glomerular ultrafiltration coefficient (Kf), which also increased early and then remained constant through the late post-donation study. Assuming that the filtration surface area (and hence, Kf) increased in proportion to renocortical volume after donation, we calculated that the 40% elevation in the single-kidney GFR observed after donation could be attributed exclusively to an increase in the Kf. The prevalence of hypertension in donors increased from 14% in the early post-donation period to 57% in the late post-donation period. No subjects exhibited elevated levels of albuminuria. CONCLUSIONS: Adaptive hyperfiltration after donor nephrectomy is attributable to hyperperfusion and hypertrophy of the remaining glomeruli. Our findings point away from the development of glomerular hypertension following kidney donation. TRIAL REGISTRATION: Not applicable. FUNDING. NIH (R01DK064697 and K23DK087937); Astellas Pharma US; the John M. Sobrato Foundation; the Satellite Extramural Grant Foundation; and the American Society of Nephrology.
BACKGROUND: Over 5,000 living kidney donor nephrectomies are performed annually in the US. While the physiological changes that occur early after nephrectomy are well documented, less is known about the long-term glomerular dynamics in living donors. METHODS: We enrolled 21 adult living kidney donors to undergo detailed long-term clinical, physiological, and radiological evaluation pre-, early post- (median, 0.8 years), and late post- (median, 6.3 years) donation. A morphometric analysis of glomeruli obtained during nephrectomy was performed in 19 subjects. RESULTS: Donors showed parallel increases in single-kidney renal plasma flow (RPF), renocortical volume, and glomerular filtration rate (GFR) early after the procedure, and these changes were sustained through to the late post-donation period. We used mathematical modeling to estimate the glomerular ultrafiltration coefficient (Kf), which also increased early and then remained constant through the late post-donation study. Assuming that the filtration surface area (and hence, Kf) increased in proportion to renocortical volume after donation, we calculated that the 40% elevation in the single-kidney GFR observed after donation could be attributed exclusively to an increase in the Kf. The prevalence of hypertension in donors increased from 14% in the early post-donation period to 57% in the late post-donation period. No subjects exhibited elevated levels of albuminuria. CONCLUSIONS: Adaptive hyperfiltration after donor nephrectomy is attributable to hyperperfusion and hypertrophy of the remaining glomeruli. Our findings point away from the development of glomerular hypertension following kidney donation. TRIAL REGISTRATION: Not applicable. FUNDING. NIH (R01DK064697 and K23DK087937); Astellas Pharma US; the John M. Sobrato Foundation; the Satellite Extramural Grant Foundation; and the American Society of Nephrology.
Authors: Aleksandar Denic; Jerry Mathew; Lilach O Lerman; John C Lieske; Joseph J Larson; Mariam P Alexander; Emilio Poggio; Richard J Glassock; Andrew D Rule Journal: N Engl J Med Date: 2017-06-15 Impact factor: 91.245
Authors: Jane C Tan; Elisa J Gordon; Mary Amanda Dew; Dianne LaPointe Rudow; Robert W Steiner; E Steve Woodle; Rebecca Hays; James R Rodrigue; Dorry L Segev Journal: Clin J Am Soc Nephrol Date: 2015-04-23 Impact factor: 8.237
Authors: Aleksandar Denic; John C Lieske; Harini A Chakkera; Emilio D Poggio; Mariam P Alexander; Prince Singh; Walter K Kremers; Lilach O Lerman; Andrew D Rule Journal: J Am Soc Nephrol Date: 2016-07-08 Impact factor: 10.121
Authors: Courtenay M Holscher; Christine E Haugen; Kyle R Jackson; Jacqueline M Garonzik Wang; Madeleine M Waldram; Sunjae Bae; Jayme E Locke; Rhiannon D Reed; Krista L Lentine; Gaurav Gupta; Matthew R Weir; John J Friedewald; Jennifer Verbesey; Matthew Cooper; Dorry L Segev; Allan B Massie Journal: Clin J Am Soc Nephrol Date: 2019-09-19 Impact factor: 8.237