Department of Clinical Medicine-Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark.
Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Anat Rec (Hoboken). 2020 Oct;303(10):2693-2701. doi: 10.1002/ar.24359. Epub 2020 Jan 25.
The demands for kidney transplantations are increasing, and so is the number of live kidney donors (LKDs). Recent studies show that LKDs have an increased risk of developing end-stage renal disease compared with healthy non-donors. However, the knowledge about factors predicting renal disease in kidney donors is sparse. Some evidence points to increased glomerular sclerosis and kidney fibrosis, as well as a low number of glomeruli as associated with a worse renal outcome. This methodological study investigated that which estimates are obtainable with a standard kidney biopsy taken from the donated kidney during the transplantation, and a standard contrast-enhanced computed tomography (CT) in kidney donors. CT-scans were used to obtain total volume of the kidney and kidney cortex using the Cavalieri estimator and 2D-nucleator. Glomerular number density in the biopsies was estimated by a model-based method, and was multiplied by total cortex volume in order to estimate the total number of glomeruli in the kidney. Glomerular volume was estimated by the 2D-nucleator and a model-based stereological technique. Kidney fibrosis (point-counting), glomerular sclerosis (evaluation of glomerular profiles), and arteriole dimensions (2D-nucleator) were also estimated in the biopsy sections from the donated kidney. Various studies have attempted to identify predictors of renal outcome in LKDs. There is no consensus yet, and further studies are needed to elucidate if and how the estimates described in this study are associated with renal outcome in LKDs.
肾移植的需求不断增加，活体肾供者（LKD）的数量也在增加。最近的研究表明，与健康的非供者相比，LKD 发生终末期肾病的风险增加。然而，关于预测肾供者肾脏疾病的因素的知识还很匮乏。一些证据表明，肾小球硬化和肾脏纤维化增加，以及肾小球数量减少与肾脏预后较差有关。这项方法学研究调查了从移植过程中捐献的肾脏中获取的标准肾脏活检以及标准对比增强计算机断层扫描（CT）可以获得哪些估计值。使用 Cavalieri 估计法和 2D-核器在 CT 扫描中获取肾脏和肾皮质的总体积。通过基于模型的方法估计活检中的肾小球数量密度，并将其乘以总皮质体积，以估计肾脏中的总肾小球数量。通过 2D-核器和基于模型的体视学技术估计肾小球体积。还在取自捐献肾脏的活检切片中估计了肾脏纤维化（点计数）、肾小球硬化（肾小球轮廓评估）和小动脉尺寸（2D-核器）。已经有多项研究试图确定 LKD 中肾脏预后的预测因子。目前尚无共识，需要进一步研究阐明本研究中描述的估计值是否以及如何与 LKD 中的肾脏预后相关。
