Bellavia Diego, Cataliotti Alessandro, Clemenza Francesco, Baravoglia Cesar Hernandez, Luca Angelo, Traina Marcello, Gridelli Bruno, Bertani Tullio, Burnett John C, Scardulla Cesare
Division of Cardiovascular Diseases, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.
Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, United States of America.
PLoS One. 2015 Nov 10;10(11):e0142103. doi: 10.1371/journal.pone.0142103. eCollection 2015.
Compensatory renal hypertrophy following unilateral nephrectomy (UNX) occurs in the remaining kidney. However, the long-term cardiac adaptive process to UNX remains poorly defined in humans. Our goal was to characterize myocardial structure and function in living kidney donors (LKDs), approximately 12 years after UNX.
Cardiac function and structure in 15 Italian LKDs, at least 5 years after UNX (median time from donation = 8.4 years) was investigated and compared to those of age and sex matched U.S. citizens healthy controls (n = 15). Standard and speckle tracking echocardiography (STE) was performed in both LKDs and controls. Plasma angiotensin II, aldosterone, atrial natriuretic peptide (ANP), N terminus pro B-type natriuretic peptide (NT-proBNP), cyclic guanylyl monophosphate (cGMP), and amino-terminal peptide of procollagen III (PIIINP) were also collected. Median follow-up was 11.9 years. In LKDs, LV geometry and function by STE were similar to controls, wall thickness and volumes were within normal limits also by CMR. In LKDs, CMR was negative for myocardial fibrosis, but apical rotation and LV torsion obtained by STE were impaired as compared to controls (21.4 ± 7.8 vs 32.7 ± 8.9 degrees, p = 0.04). Serum creatinine and PIIINP levels were increased [1.1 (0.9-1.3) mg/dL, and 5.8 (5.4-7.6)] μg/L, respectively), while urinary cGMP was reduced [270 (250-355) vs 581 (437-698) pmol/mL] in LKDs. No LKD developed cardiovascular or renal events during follow-up.
Long-term kidney donors have no apparent structural myocardial abnormalities as assessed by contrast enhanced CMR. However, myocardial deformation of the apical segments, as well as apical rotation, and LV torsion are reduced. The concomitant increase in circulating PIIINP level is suggestive of fibrosis. Further studies, focused on US and EU patients are warranted to evaluate whether these early functional modifications will progress to a more compromised cardiac function and structure at a later time.
单侧肾切除术后，剩余肾脏会发生代偿性肾肥大。然而，人类对单侧肾切除的长期心脏适应性过程仍知之甚少。我们的目标是描述活体肾供者（LKDs）在单侧肾切除术后约12年时的心肌结构和功能。
对15例意大利LKDs（单侧肾切除术后至少5年，捐献后中位时间 = 8.4年）的心脏功能和结构进行了研究，并与年龄和性别匹配的美国健康对照者（n = 15）进行比较。对LKDs和对照者均进行了标准和斑点追踪超声心动图（STE）检查。还收集了血浆血管紧张素II、醛固酮、心房利钠肽（ANP）、N末端B型利钠肽原（NT-proBNP）、环磷酸鸟苷（cGMP）和III型前胶原氨基端肽（PIIINP）。中位随访时间为11.9年。在LKDs中，STE检测的左心室几何形状和功能与对照者相似，心脏磁共振成像（CMR）显示室壁厚度和容积也在正常范围内。在LKDs中，CMR显示心肌纤维化呈阴性，但与对照者相比，STE检测的心尖旋转和左心室扭转受损（21.4±7.8度对32.7±8.9度，p = 0.04）。LKDs的血清肌酐和PIIINP水平升高[分别为1.1（0.9 - 1.3）mg/dL和5.8（5.4 - 7.6）μg/L]，而尿cGMP降低[270（250 - 355）对581（437 - 698）pmol/mL]。随访期间，没有LKD发生心血管或肾脏事件。
通过对比增强CMR评估，长期肾供者没有明显的心肌结构异常。然而，心尖节段的心肌变形以及心尖旋转和左心室扭转减少。循环中PIIINP水平的同时升高提示纤维化。有必要针对美国和欧盟患者开展进一步研究，以评估这些早期功能改变是否会在后期发展为更严重的心脏功能和结构损害。
