Figurek Andreja, Luyckx Valerie A, Mueller Thomas F
Clinic for Nephrology, University Hospital Zurich, Zurich, Switzerland.
Institute of Anatomy, University of Zurich, Zurich, Switzerland.
Kidney Int Rep. 2020 Jan 20;5(4):448-458. doi: 10.1016/j.ekir.2019.12.021. eCollection 2020 Apr.
The kidney's capacity to increase its glomerular filtration rate (GFR) in response to a higher functional demand is known as the renal functional reserve (RFR). Good short-term outcomes after living kidney donation have led to more acceptance of borderline donors (with hypertension, obesity, older age) due the ongoing shortage of donor organs. Given recent concerns about increased long-term risk in some donor subgroups, better donor stratification is needed. Measurement of RFR could inform assessment of donor risk.
A systematic literature review of studies that assessed RFR in donors pre- and/or post-donation was performed. Given study heterogeneity, descriptive analysis and narrative synthesis was conducted.
Sixteen of 3250 identified studies published between 1956 and 2019 met inclusion criteria. Most studies were cross-sectional and conducted before ( = 8) and/or after ( = 16) kidney donation. Methods for measurement of GFR, effective renal plasma flow (ERPF) and RFR were not standardized. Changes in filtration fraction (FF) and ERPF relative to GFR observed after donation varied depending on stimulus used to induce RFR. Overall, RFR fell after donation; however, over the shorter term, RFR was largely preserved in young healthy donors. RFR was more significantly reduced in donors with hypertension, obesity, or older age.
Existing data suggest possible blunting of RFR post-donation in older, obese, and hypertensive donors, which may represent increased single-nephron GFR at baseline. The long-term implications of these changes deserve further study to determine utility in informing selection of borderline kidney donors.
肾脏在功能需求增加时提高其肾小球滤过率（GFR）的能力被称为肾功能储备（RFR）。由于供体器官持续短缺，活体肾移植后良好的短期结果使得更多边缘供体（患有高血压、肥胖症、年龄较大）被接受。鉴于最近对某些供体亚组中长期风险增加的担忧，需要更好地对供体进行分层。RFR的测量可为供体风险评估提供依据。
对评估供体捐献前和/或捐献后RFR的研究进行系统的文献综述。鉴于研究的异质性，进行了描述性分析和叙述性综合。
在1956年至2019年间发表的3250项已识别研究中，有16项符合纳入标准。大多数研究是横断面研究，在肾移植前（n = 8）和/或后（n = 16）进行。GFR、有效肾血浆流量（ERPF）和RFR的测量方法未标准化。捐献后观察到的滤过分数（FF）和ERPF相对于GFR的变化因诱导RFR的刺激因素而异。总体而言，捐献后RFR下降；然而，在短期内，年轻健康供体的RFR在很大程度上得以保留。高血压、肥胖或年龄较大的供体中，RFR下降更为显著。
现有数据表明，老年、肥胖和高血压供体捐献后RFR可能减弱，这可能代表基线时单个肾单位GFR增加。这些变化的长期影响值得进一步研究，以确定其在指导边缘肾供体选择方面的效用。
