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Relationship between renal volume growth and renal function in autosomal dominant polycystic kidney disease: a
Godela M Fick-Brosnahan1, Mark M Belz, Kim K McFann
1Department of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
Insights
Renal volume and its growth rate are key indicators of autosomal dominant polycystic kidney disease (ADPKD) progression. These markers are valuable for monitoring disease in early stages, even when kidney function is preserved.
Area of Science:
- Nephrology
- Medical Imaging
- Genetics
Background:
- Autosomal dominant polycystic kidney disease (ADPKD) is characterized by progressive cyst formation and expansion.
- Renal function is typically preserved for many years in adult ADPKD patients.
- Longitudinal data on renal volume growth, hypertension, and kidney function decline in ADPKD are limited.
Purpose of the Study:
- To examine the longitudinal relationships between renal volume growth, hypertension, and renal function loss in ADPKD.
- To identify potential markers for disease progression in early-stage ADPKD.
Main Methods:
- A longitudinal study of 229 adult ADPKD subjects from 1985 to 2001.
- Sequential ultrasound examinations to calculate renal volume.
- Glomerular filtration rate (GFR) calculated using the Modified Diet in Renal Disease (MDRD) equation.
- Statistical analysis including multiple linear regression and correlational analysis.
Main Results:
- Mean annual increase in renal volume was 46 cm3; mean annual decline in GFR was 2.4 mL/min/1.73 m2.
- Men exhibited faster renal growth, more severe hypertension, and a faster GFR decline than women.
- Significant relationships were found between GFR change rate and renal volume growth rate, initial renal volume, proteinuria, and age.
- Strong correlations (R = -0.53 and R = -0.50) existed between GFR and renal volume over time.
Conclusions:
- Renal volume and its growth rate may serve as useful markers for monitoring ADPKD progression.
- These markers are particularly valuable in the early stages of ADPKD when GFR is still preserved.
- Understanding these relationships aids in managing ADPKD patients with preserved renal function.
Abstract:
In autosomal dominant polycystic kidney disease (ADPKD), renal function remains normal for many years into adult life while cysts form and expand progressively, starting in childhood. The longitudinal relationships between renal volume growth, hypertension, and renal function loss have not been examined in detail. At the University of Colorado (Denver, CO), 229 adult subjects with ADPKD participated in a longitudinal study from 1985 to 2001. Sequential ultrasound examinations were performed at a mean interval of 7.8 +/- 3.1 years (range, 2.6 to 15.1 years). Renal volume was calculated using a standard formula for a modified ellipsoid. The Modified Diet in Renal Disease equation was used to calculate glomerular filtration rate (GFR). The mean annual increase in renal volume was 46 +/- 55 cm3, and mean annual decline in GFR was 2.4 +/- 2.8 mL/min/1.73 m2. Men had faster renal growth, more severe hypertension, and a faster decline in GFR than women of similar ages. Multiple linear regression showed a significant relationship between rate of change in GFR and renal volume growth rate, initial renal volume, proteinuria, and age at entry. Correlational analysis showed a significant correlation between GFR and renal volume over time (R = -0.53) and between follow-up renal volume and follow-up GFR (R = -0.50) for both men and women. We conclude that renal volume and rate of renal volume growth may be useful markers for disease progression in early stages of ADPKD when GFR is preserved.