Denic Aleksandar, Mathew Jerry, Lerman Lilach O, Lieske John C, Larson Joseph J, Alexander Mariam P, Poggio Emilio, Glassock Richard J, Rule Andrew D
From the Divisions of Nephrology and Hypertension (A.D., J.M., L.O.L., J.C.L., A.D.R.), Biomedical Statistics and Informatics (J.J.L.), and Epidemiology (A.D.R.) and the Department of Laboratory Medicine and Pathology (J.C.L., M.P.A.), Mayo Clinic, Rochester, MN; the Department of Nephrology, Cleveland Clinic, Cleveland (E.P.); and the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles (R.J.G.).
N Engl J Med. 2017 Jun 15;376(24):2349-2357. doi: 10.1056/NEJMoa1614329.
The glomerular filtration rate (GFR) assesses the function of all nephrons, and the single-nephron GFR assesses the function of individual nephrons. How the single-nephron GFR relates to demographic and clinical characteristics and kidney-biopsy findings in humans is unknown.
We identified 1388 living kidney donors at the Mayo Clinic and the Cleveland Clinic who underwent a computed tomographic (CT) scan of the kidney with the use of contrast material and an iothalamate-based measurement of the GFR during donor evaluation and who underwent a kidney biopsy at donation. The mean single-nephron GFR was calculated as the GFR divided by the number of nephrons (calculated as the cortical volume of both kidneys as assessed on CT times the biopsy-determined glomerular density). Demographic and clinical characteristics and biopsy findings were correlated with the single-nephron GFR.
A total of 58% of the donors were women, and the mean (±SD) age of the donors was 44±12 years. The mean GFR was 115±24 ml per minute, the mean number of nephrons was 860,000±370,000 per kidney, and the mean single-nephron GFR was 80±40 nl per minute. The single-nephron GFR did not vary significantly according to age (among donors <70 years of age), sex, or height (among donors ≤190 cm tall). A higher single-nephron GFR was independently associated with larger nephrons on biopsy and more glomerulosclerosis and arteriosclerosis than would be expected for age. A higher single-nephron GFR was associated with a height of more than 190 cm, obesity, and a family history of end-stage renal disease.
Among healthy adult kidney donors, the single-nephron GFR was fairly constant with regard to age, sex, and height (if ≤190 cm). A higher single-nephron GFR was associated with certain risk factors for chronic kidney disease and certain kidney-biopsy findings. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases.).
肾小球滤过率(GFR)评估所有肾单位的功能,而单肾单位GFR评估单个肾单位的功能。单肾单位GFR与人类的人口统计学和临床特征以及肾活检结果之间的关系尚不清楚。
我们在梅奥诊所和克利夫兰诊所确定了1388名活体肾供者,他们在供者评估期间接受了使用造影剂的肾脏计算机断层扫描(CT)以及基于碘他拉酸盐的GFR测量,并在捐献时接受了肾活检。平均单肾单位GFR计算为GFR除以肾单位数量(通过CT评估的双侧肾脏皮质体积乘以活检确定的肾小球密度计算得出)。人口统计学和临床特征以及活检结果与单肾单位GFR相关。
共有58%的供者为女性,供者的平均(±标准差)年龄为44±12岁。平均GFR为每分钟115±24 ml,每个肾脏的平均肾单位数量为860,000±370,000个,平均单肾单位GFR为每分钟80±40 nl。单肾单位GFR在年龄(70岁以下的供者中)、性别或身高(身高≤190 cm的供者中)方面没有显著差异。较高的单肾单位GFR与活检时较大的肾单位以及比预期年龄更多的肾小球硬化和动脉硬化独立相关。较高的单肾单位GFR与身高超过190 cm、肥胖以及终末期肾病家族史相关。
在健康成年肾供者中,单肾单位GFR在年龄、性别和身高(如果≤190 cm)方面相当恒定。较高的单肾单位GFR与慢性肾脏病的某些危险因素以及某些肾活检结果相关。(由国立糖尿病、消化和肾脏疾病研究所资助。)