Long-term follow-up of a human subject with a remnant kidney

It has been proposed that once functioning renal mass has been reduced below a critical level, either as the result of disease, congenital absence of a kidney, or surgical ablation, that hyperfiltration and glomerular hypertension lead to progressive glomerular sclerosis and end-stage renal failure. We report the clinical course and renal function of a human subject followed for 10.8 years after extensive renal ablation. Functioning renal mass was estimated at one fourth to one fifth of normal. During the follow-up period, creatinine clearance increased from 0.27 mL/s (16 mL/min) to 0.88 mL/s (53 mL/min), the total renal plasma flow (all of which was to the left kidney) increased from 62 mL/min to 190 mL/min, and 24-hour urine protein excretion increased from 0.09 g to 0.4 g. Despite probable glomerular hyperfiltration, neither progressive glomerular dysfunction nor end-stage renal failure developed over a period of 10 years.