Evaluation of potential long-term changes in endothelial functions and basic echocardiographic parameters in...

Decreased nephron count may result in lower glomerular filtration rate (GFR) and cardiorenal injury in the absence of compensatory hyperfunction. In this study, we aimed to evaluate long-term effects of 50% nephron loss on endothelial functions and cardiac morphology in nondonor nephrectomy patients.

This study comprised 26 patients (median age: 44 [37.5-50] years, male: 14) with unilateral nephrectomy and 25 healthy controls (median age: 47 [42-50] years, male: 9). Echocardiography was performed in all patients. Endothelial function was examined by measuring ischemia-induced flow-mediated dilation (FMD) of the brachial artery.

The mean nephrectomy time was 12.5 (8.75-23.25) years. Estimated glomerular filtration rate (eGFR [CKD-EPI]) was significantly lower in the patient group than controls (85.54±16.27 vs 96.35±11.68 mL/min, P=0.009). Uric acid levels were significantly higher in the patient group than controls (5.7±1.3 vs 4.5±0.8, P<0.001). Percentage of FMD was significantly lower in the unilateral nephrectomy patients than the control group (11.6±6.2 vs 16.1%±7.9%; P=0.029). Left ventricular posterior wall thickness (LVPWT) (P<0.001), interventricular septal thickness (IVST) (P<0.001), left ventricular (LV) mass (P=0.014), and left ventricular mass index (P=0.014) were significantly higher in the patient group.

In conclusion, 50% decrease in nephron mass due to unilateral nephrectomy may result in decreased eGFR, impaired endothelial functions and cardiac hypertrophy. What triggers endothelial dysfunction and cardiac hypertrophy in the event of mild decrease in GFR when creatinine has not been elevated yet remains unclear, but uric acid may be playing a role in this process necessitating large-scaled studies.