Lenihan Colin R, Busque Stephan, Derby Geraldine, Blouch Kristina, Myers Bryan D, Tan Jane C
J Clin Invest. 2015 Mar 2;125(3):1311-8. doi: 10.1172/JCI78885. Epub 2015 Feb 17.
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.
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.
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.
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.
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.
在美国，每年有超过5000例活体肾供体肾切除术。虽然肾切除术后早期发生的生理变化已有充分记录，但对于活体供体的长期肾小球动态变化了解较少。
我们招募了21名成年活体肾供体，在捐献前、捐献后早期（中位数为0.8年）和捐献后晚期（中位数为6.3年）进行详细的长期临床、生理和放射学评估。对19名受试者在肾切除术中获取的肾小球进行形态计量分析。
供体在手术后早期单肾肾血浆流量（RPF）、肾皮质体积和肾小球滤过率（GFR）平行增加，这些变化一直持续到捐献后晚期。我们使用数学模型估计肾小球超滤系数（Kf），其在捐献后早期也增加，然后在捐献后晚期研究中保持恒定。假设捐献后滤过表面积（因此Kf）与肾皮质体积成比例增加，我们计算出捐献后观察到的单肾GFR升高40%可完全归因于Kf的增加。供体中高血压的患病率从捐献后早期的14%增加到捐献后晚期的57%。没有受试者表现出蛋白尿水平升高。
供体肾切除术后的适应性高滤过归因于剩余肾小球的高灌注和肥大。我们的研究结果表明肾捐献后不会发生肾小球高血压。
不适用。资金来源：美国国立卫生研究院（R01DK064697和K23DK087937）；美国安斯泰来制药公司；约翰·M·索布拉托基金会；卫星校外资助基金会；以及美国肾脏病学会。
