Na Joon Chae, Yoon Min-Gee, Lee Hyung Ho, Yoon Young Eun, Kim Deok Gie, Huh Kyu Ha, Kim Yu Seun, Han Woong Kyu
Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Korea.
Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang-si, Korea.
Transplant Proc. 2019 Oct;51(8):2543-2548. doi: 10.1016/j.transproceed.2019.03.081. Epub 2019 Aug 28.
In this study, we evaluated the occurrence of proteinuria in living kidney donors during the immediate postdonation period, aiming to determine its clinical significance in renal function recovery.
We enrolled living kidney donors with predonation protein excretion rate (PER) < 150 mg/24 h. Participants were divided into 2 groups according to immediate postdonation PER (4 days after nephrectomy): non-microproteinuria (non-mPr; PER < 150 mg/24 h), n = 244; and immediate postdonation microproteinuria (ImPr; PER ≥ 150 mg/24 h), n = 605.
Estimated glomerular filtration rate (eGFR) did not differ significantly between groups immediately after nephrectomy but was consistently lower in the ImPr group 1 week to 1 year postdonation (1-year postdonation eGFR: ImPr group, 63.6 ± 12.1 mL/min/1.73 m; non-mPr group, 68.6 ± 12.3 mL/min/1.73 m; P = .001). Immediate postdonation microproteinuria was an independent predictor of eGFR at 1 year postdonation (β [standard error] = -2.68 [1.15], 95% confidence interval -4.94 to -0.42, P = .02), along with predonation eGFR, age, and sex. Immediate postdonation microproteinuria was more common in donors who were older or male and occurred in 71.3% of kidney donors, suggesting renal injury in this period.
Although proteinuria generally resolves, its impact persists and can impair renal function recovery. Donors who are older and male are more likely to undergo immediate hyperfiltration after donation.
在本研究中，我们评估了活体肾供者术后即刻蛋白尿的发生情况，旨在确定其在肾功能恢复中的临床意义。
我们纳入了术前蛋白排泄率（PER）<150mg/24h的活体肾供者。根据术后即刻（肾切除术后4天）的PER将参与者分为2组：非微量蛋白尿组（非mPr；PER<150mg/24h），n = 244；术后即刻微量蛋白尿组（ImPr；PER≥150mg/24h），n = 605。
肾切除术后即刻两组间的估算肾小球滤过率（eGFR）无显著差异，但在术后1周~1年ImPr组的eGFR持续较低（术后1年eGFR：ImPr组，63.6±12.1ml/min/1.73m²；非mPr组，68.6±12.3ml/min/1.73m²；P = 0.001）。术后即刻微量蛋白尿是术后1年eGFR的独立预测因素（β[标准误]= -2.68[1.15]，95%置信区间-4.94至-0.42，P = 0.02），同时也是术前eGFR、年龄和性别的预测因素。术后即刻微量蛋白尿在年龄较大或男性供者中更为常见，在71.3%的肾供者中出现，提示这一时期存在肾损伤。
虽然蛋白尿通常会消退，但其影响持续存在并可能损害肾功能恢复。年龄较大和男性供者在捐献后更有可能立即发生超滤。
