Kidney Microstructural Features at the Time of Donation Predict Long-term Risk of Chronic Kidney Disease in Living Kidney Donors |
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Authors: | Massini A Merzkani Aleksandar Denic Ramya Narasimhan Camden L Lopez Joseph J Larson Walter K Kremers Harini A Chakkera Walter D Park Sandra J Taler Mark D Stegall Mariam P Alexander Naim Issa Andrew D Rule |
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Institution: | 1. Divisions of Nephrology & Hypertension, Mayo Clinic, Rochester, MN;2. Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN;3. Division of Nephrology, Mayo Clinic Arizona, Scottsdale, AZ;4. William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN;5. Department of Pathology, Mayo Clinic, Rochester, MN |
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Abstract: | ObjectiveTo determine whether microstructural features on a kidney biopsy specimen obtained during kidney transplant surgery predict long-term risk of chronic kidney disease in the donor.Patients and MethodsWe studied kidney donors from May 1, 1999, through December 31, 2018, with a follow-up survey for the results of recent blood pressure and kidney function tests (estimated glomerular filtration rate eGFR] and proteinuria). If not recently available, blood pressure and eGFRs were requested from a local clinic. Microstructural features on kidney biopsy at the time of donation were assessed as predictors of hypertension and kidney function after adjusting for years of follow-up, baseline age, sex, and clinical predictors.ResultsThere were 807 donors surveyed a mean 10.5 years after donation. An eGFR less than 45 mL/min/1.73 m2 in 6.4% (43/673) of donors was predicted by larger glomerular volume per standard deviation (odds ratio OR], 1.48; 95% CI, 1.08 to 2.04) and nephron number below the age-specific 5th percentile (OR, 3.38; 95% CI, 1.31 to 8.72). An eGFR less than 60 mL/min/1.73 m2 in 42.5% (286/673) of donors was not predicted by any microstructural feature. Residual eGFR (postdonation/predonation eGFR) was predicted by nephron number below the age-specific 5th percentile (difference, ?6.07%; 95% CI, ?10.24% to ?1.89%). Self-reported proteinuria in 5.1% (40/786) of donors was predicted by larger glomerular volume (OR, 1.42; 95% CI, 1.08 to 1.86). Incident hypertension in 18.8% (119/633) of donors was not predicted by any microstructural features.ConclusionLow nephron number for age and larger glomeruli are important microstructural predictors for long-term risk of chronic kidney disease after living kidney donation. |
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Keywords: | AKA"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"Aging Kidney Anatomy BMI"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"body mass index CKD"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"chronic kidney disease CT"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"computed tomography DBP"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"diastolic blood pressure eGFR"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"estimated glomerular filtration rate ESRD"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"end-stage renal disease GFR"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"glomerular filtration rate GSG"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"globally sclerotic glomeruli IF/TA"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"interstitial fibrosis/tubular atrophy SBP"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"systolic blood pressure |
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