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Glomerular hyperfiltration after unilateral nephrectomy in living kidney donors
H A Bock1, M Bachofen, J Landmann
1Division of Nephrology, Department of Internal Medicine, Kantonsspital, Basel, Switzerland.
Summary
Living kidney donors experience temporary hyperfiltration and hyperperfusion post-surgery. These changes did not show adverse effects on kidney function or blood pressure within one year.
Area of Science:
- Nephrology
- Transplant Surgery
- Physiology
Background:
- Living donor kidney transplantation involves uninephrectomy, potentially leading to donor kidney damage from hyperfiltration.
- Assessing the impact of uninephrectomy on donor kidney function is crucial for donor safety.
Purpose of the Study:
- To prospectively evaluate renal function, albumin excretion, and blood pressure in living kidney donors after uninephrectomy.
- To investigate the occurrence and consequences of hyperfiltration and hyperperfusion in the remaining donor kidney.
Main Methods:
- Prospective measurement of inulin and para-aminohippuric acid (PAH) clearance, albumin excretion, and blood pressure in 30 living kidney donors.
- Measurements were taken pre-uninephrectomy, and at 1 week and 1 year post-nephrectomy.
- Hyperfiltration and hyperperfusion were calculated based on clearance values.
Main Results:
- Hyperfiltration averaged 128% and hyperperfusion 133% at 1 week post-nephrectomy, remaining elevated at 1 year (126% for hyperfiltration).
- Hyperperfusion significantly decreased by 1 year (118%, P < 0.02), while hyperfiltration remained stable.
- No significant changes in blood pressure or new hypertension cases were observed; microalbuminuria was transient in some donors.
Conclusions:
- Hyperfiltration and hyperperfusion occur after uninephrectomy in living kidney donors.
- No demonstrable adverse effects on renal function or blood pressure were observed within the 1-year follow-up period.
- The long-term significance of transient microalbuminuria warrants further investigation.