ter Wee P M, Tegzess A M, Donker A J
Department of Medicine, Free University Hospital, Amsterdam, The Netherlands.
J Am Soc Nephrol. 1994 Apr;4(10):1798-808. doi: 10.1681/ASN.V4101798.
Subjects after kidney donation manifest an adaptive rise in GFR. In uninephrectomized rats, progressive glomerulosclerosis, which is induced by the compensatory glomerular hyperfiltration, develops. It has been assumed that testing the existence of renal reserve filtration capacity (RRFC) might be used to demonstrate such glomerular hyperfiltration in humans. In a paired way, the RRFC of 15 kidney recipients and their donors were investigated long term (4.9 +/- 0.8 (SE) yr) after surgery. Continuous infusions of (125I)iothalamate and (131I)hippuran were used to measure GFR and effective RPF (ERPF). RRFC was tested by the infusion of dopamine, amino acids, and a combined infusion of these agents. The GFR, ERPF, and RRFC of the recipients did not differ from that of their donors. RRFC had also been tested in 12 donors, before and short term (1.3 +/- 0.3 (SE) months) after the kidney donation. Thus, the RRFC of the kidney donors could be monitored longitudinally. GFR measured short term after kidney donation amounted to 62% (+/- 2.1% SE) of the value before donation and to 68% (+/- 1.7% SE; P < 0.005) of the value long term after donation. Short- and long-term ERPF both amounted to 68% of the value before donation. The RRFC tested with the amino acids of the donors before kidney donation did not differ from that either short-term or long term after donation. Likewise, the RRFC tested with the amino acids of the recipients was similar to that of the donors before kidney donation. In contrast, in kidney recipients and donors, both short and long term after donation, RRFC tested with dopamine was approximately halved compared with that of the donors before donation. It was concluded, first, that testing RRFC cannot be used to test the existence of maladaptive glomerular hyperfiltration in subjects with a single kidney: Second, GFR increases for years after kidney donation, probably because of the compensatory hypertrophy of the remaining kidney.
肾移植受者术后肾小球滤过率（GFR）会适应性升高。在单侧肾切除的大鼠中，由代偿性肾小球高滤过引起的进行性肾小球硬化会发展。据推测，测试肾储备滤过能力（RRFC）的存在可能用于证明人类的这种肾小球高滤过。采用配对方式，对15名肾移植受者及其供者术后长期（4.9±0.8（标准误）年）的RRFC进行了研究。持续输注（125I）碘肽酸盐和（131I）马尿酸来测量GFR和有效肾血浆流量（ERPF）。通过输注多巴胺、氨基酸以及这些药物的联合输注来测试RRFC。受者的GFR、ERPF和RRFC与供者无差异。还对12名供者在肾移植前及术后短期（1.3±0.3（标准误）个月）进行了RRFC测试。因此，可以纵向监测肾供者的RRFC。肾移植术后短期测量的GFR相当于术前值的62%（±2.1%标准误），术后长期值的68%（±1.7%标准误；P<0.005）。短期和长期的ERPF均相当于术前值的68%。肾移植前供者用氨基酸测试的RRFC与术后短期或长期无差异。同样，受者用氨基酸测试的RRFC与肾移植前供者相似。相比之下，肾移植受者和供者在术后短期和长期，用多巴胺测试的RRFC与肾移植前供者相比约减半。得出的结论是，首先，测试RRFC不能用于检测单肾受试者中适应性不良的肾小球高滤过的存在；其次，肾移植术后数年GFR升高，可能是由于剩余肾脏的代偿性肥大。
