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Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis Among Apparently Healthy Adults
Aleksandar Denic1, Mariam P Alexander2, Vidhu Kaushik2
1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota.
Insights
Even healthy adults can have kidney pathology. Nephron hypertrophy and nephrosclerosis, common in kidney donors, have distinct associations with kidney function, structure, and risk factors.
Area of Science:
- Nephrology
- Renal Pathology
- Medical Imaging
Background:
- Mild kidney pathology is common even in healthy adults.
- The relationship between kidney microstructural variations, imaging findings, and clinical patterns is not well understood.
Purpose of the Study:
- To investigate the associations between kidney microstructural findings (nephron hypertrophy and nephrosclerosis) and clinical factors in living kidney donors.
- To correlate imaging-derived kidney macrostructure with histologically determined microstructural changes.
Main Methods:
- Cross-sectional study involving 1,520 living kidney donors.
- Analysis of predonation kidney function, risk factors, and contrast-enhanced CT scans.
- Histological assessment of kidney cortex biopsies for nephrosclerosis and nephron size.
Main Results:
- Nephrosclerosis correlated with increased kidney surface roughness, cysts, and lower cortical to medullary volume ratio.
- Nephron hypertrophy was linked to larger cortical volume, higher blood pressure, glomerular filtration rate, albuminuria, BMI, uric acid, and family history of ESRD.
- Both hypertrophy and nephrosclerosis were associated with older age and mild hypertension, with hypertrophy mitigating age- and hypertension-related volume loss.
Conclusions:
- Living kidney donors, while healthy, exhibit a spectrum of microstructural kidney changes.
- Nephron hypertrophy and nephrosclerosis have different clinical and structural associations in apparently healthy individuals.
- Imaging and biopsy findings provide insights into kidney health beyond standard clinical parameters.
Background:
Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear.
Study Design:
Cross-sectional (clinical-pathologic correlation).
Setting & Participants:
Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011.
Predictors:
Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness.
Outcomes:
Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation.
Results:
Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis.
Limitations:
Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings.
Conclusions:
Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.
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