Baylor Transplant Institute, Dallas, TX 75246, USA.
Transplantation. 2010 Sep 15;90(5):575-80. doi: 10.1097/TP.0b013e3181e64237.
Living kidney transplant donors generally have a favorable renal functional outcome postuninephrectomy, but concern remains that a reduced glomerular filtration rate (GFR) postuninephrectomy might have harmful effects. This study examines the short-term (3 months) effect of donor nephrectomy on GFR and the occurrence of stage 3 chronic kidney disease (CKD) postuninephrectomy.
The prevalence of stage 3 CKD (Kidney Disease Quality Outcome Initiative [GFR<60 mL/min/1.73 m]) was examined in 196 living donors by comparing preuninephrectomy and 3-month postuninephrectomy values of GFR using I-iothalamate GFR (iGFR), modification of diet in renal disease estimated GFR (eGFR), Cockcroft-Gault estimated creatinine clearance, and endogenous 24-hr creatinine clearance. The accuracy of GFR estimations for predicting iGFR was also studied.
The mean GFR before and after donation were iGFR, 105+/-18 and 68+/-13 mL/min/1.73 m; eGFR, 98+/-19 and 63+/-12 mL/min/1.73 m; Cockcroft-Gault estimated creatinine clearance, 125+/-33 and 85+/-22 mL/min/1.73 m, and endogenous 24-hr creatinine clearance, 133+/-38 and 86+/-24 mL/min/1.73 m, respectively. Stage 3 CKD was found postuninephrectomy in 53 donors (27%) by iGFR and in 73 donors (38%) by eGFR. The prevalence of stage 3 CKD was greater with older age. GFR estimation equations did not accurately predict iGFR, particularly postuninephrectomy.
Stage 3 CKD is commonly observed after living kidney donation, particularly in older donors. The long-term impact of stage 3 CKD postuninephrectomy is poorly understood and may not have the same implications as stage 3 CKD in other conditions. eGFR is a poor predictor of true GFR in kidney donors.
活体肾移植供者术后肾功能通常良好，但仍有人担心术后肾小球滤过率（GFR）下降可能会产生有害影响。本研究探讨了供肾切除术后短期内（3 个月）对 GFR 的影响以及术后发生 3 期慢性肾脏病（CKD）的情况。
通过比较 i-碘海醇 GFR（iGFR）、肾脏病饮食改良试验估计的 GFR（eGFR）、 Cockcroft-Gault 估计的肌酐清除率和内源性 24 小时肌酐清除率，比较 196 例活体供者术前和术后 3 个月的 GFR 值，来检测 3 期 CKD（肾脏病改善全球结局倡议[GFR<60mL/min/1.73m]）的患病率。还研究了 GFR 估计值预测 iGFR 的准确性。
供肾前后的平均 GFR 分别为 iGFR：105±18 和 68±13mL/min/1.73m；eGFR：98±19 和 63±12mL/min/1.73m；Cockcroft-Gault 估计的肌酐清除率：125±33 和 85±22mL/min/1.73m，以及内源性 24 小时肌酐清除率：133±38 和 86±24mL/min/1.73m。iGFR 术后发现 53 例（27%）供者发生 3 期 CKD，eGFR 术后发现 73 例（38%）供者发生 3 期 CKD。年龄较大的供者更易发生 3 期 CKD。GFR 估计方程不能准确预测 iGFR，尤其是在供肾切除术后。
活体肾捐献后常发生 3 期 CKD，尤其是在年龄较大的供者中。术后 3 期 CKD 的长期影响尚不清楚，其意义可能与其他情况下的 3 期 CKD 不同。eGFR 是肾供者真实 GFR 的一个较差预测指标。
