Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Acta Med Indones. 2020 Jul;52(3):264-273.
living kidney donation is a safe medical procedure. Kidney function after donation is crucial for donors' health and quality of life. Kidney hyperfiltration is a compensatory mechanism, which will preserve kidney function after unilateral nephrectomy. The number of studies regarding hyperfiltration in living kidney donors is limited. Our study aimed to explain kidney hyperfiltration mechanism and evaluate its effect on the kidney function within 30 days after surgery.
our study was a prospective cohort study with 46 living-kidney donors participating in the study between April and December 2019. We evaluated main outcomes, the 30-day post-surgery kidney function, which was evaluated by calculating estimated glomerular filtration rate (eGFR) and Urinary Albumin to Creatinine Ratio (ACR). The subjects were categorized into two groups based on their 30-day outcomes, which were the adaptive (eGFR > 60 mL/min/1.73 m2 and/or ACR > 30 mg/g) and maladaptive (eGFR < 60 mL/min/1.73 m2 and/or ACR > 30 mg/g) groups. A series of evaluation including calculating the renal arterial resistive index (RI) and measuring urinary vascular endothelial growth factor (VEGF), neutrophil gelatinase-associated lipocalin (NGAL), and heparan sulfate (HS) levels were performed before surgery and serially until 30 days after surgery. Multivariate analysis with adjustments for confounding factors was done.
forty donors were included and mostly were female (67.5%). The average age and body mass index (BMI) were 45.85 (SD 9.74) years old and 24.36 (SD 3.73) kg/m2, respectively. Nineteen donors (47.5%) had maladaptive hyperfiltration outcomes. The hyperfiltration process was demonstrated by significant changes in renal arterial RI, urinary VEGF, NGAL, and HS levels (p<0.005). There was no significant difference regarding RI, urinary VEGF, NGAL, and HS levels between both groups. Several confounding factors (BMI over 25 kg/m2, familial relationship, age over 40 years old, and arterial stiffness) were significantly influenced by kidney hyperfiltration and outcomes (p<0.05).
the hyperfiltration process does not affect the 30-day post-nephrectomy kidney function of the donors. Several other factors may influence the hyperfiltration process and kidney function. Further study is necessary to evaluate kidney function and its other related variables with a longer period of time study duration.
活体肾脏捐献是一种安全的医疗程序。捐献后肾脏的功能对供者的健康和生活质量至关重要。肾脏高滤过是一种代偿机制，可在单侧肾切除术后保护肾脏功能。关于活体肾脏供者高滤过的研究数量有限。我们的研究旨在解释肾脏高滤过的机制，并评估其对术后 30 天内肾脏功能的影响。
我们的研究是一项前瞻性队列研究，共有 46 名活体肾脏供者参与了 2019 年 4 月至 12 月期间的研究。我们评估了主要结局，即术后 30 天的肾脏功能，通过计算估算肾小球滤过率（eGFR）和尿白蛋白与肌酐比（ACR）来评估。根据术后 30 天的结果将受试者分为两组，即适应性组（eGFR＞60mL/min/1.73m2和/或 ACR＞30mg/g）和失代偿性组（eGFR＜60mL/min/1.73m2和/或 ACR＞30mg/g）。在手术前和手术后连续测量一系列指标，包括计算肾动脉阻力指数（RI）和测量尿血管内皮生长因子（VEGF）、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和硫酸乙酰肝素（HS）水平。对混杂因素进行了多变量分析。
共有 40 名供者入组，其中大多数为女性（67.5%）。平均年龄和体重指数（BMI）分别为 45.85（SD 9.74）岁和 24.36（SD 3.73）kg/m2。19 名供者（47.5%）出现失代偿性高滤过。肾动脉 RI、尿 VEGF、NGAL 和 HS 水平的显著变化表明高滤过过程的发生（p＜0.005）。两组间 RI、尿 VEGF、NGAL 和 HS 水平无显著差异。BMI＞25kg/m2、亲属关系、年龄＞40 岁和动脉僵硬等几个混杂因素（p＜0.05）对高滤过过程和结局有显著影响。
高滤过过程不会影响供者术后 30 天的肾脏功能。其他一些因素可能会影响高滤过过程和肾脏功能。需要进一步的研究来评估肾脏功能及其它相关变量在更长时间的研究期间的变化。
