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Renal functional reserve in transplanted and native single kidneys of children and adults
M S Englund1, U B Berg, K Arfwidson
1Department of Pediatrics, Huddinge University Hospital, Karolinska Institute, Sweden.
Insights
Children who received kidney transplants and are on cyclosporine medication demonstrate preserved renal functional reserve. This indicates their kidneys can adapt to increased demands, a crucial finding for long-term transplant success.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Transplantation Immunology
Background:
- Cyclosporine is a common immunosuppressant after kidney transplantation.
- Assessing renal functional reserve (RFR) is vital for monitoring kidney health post-transplant.
- Limited data exists on RFR in pediatric kidney transplant recipients on cyclosporine.
Purpose of the Study:
- To evaluate renal functional reserve (RFR) in pediatric kidney transplant recipients treated with cyclosporine.
- To compare RFR in kidney transplant recipients with healthy kidney donors and children with single kidneys.
- To investigate the relationship between RFR and kidney size in transplant recipients.
Main Methods:
- Oral protein load was administered to assess RFR.
- Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were measured using inulin and para-aminohippurate clearances.
- RFR was calculated by comparing stimulated and baseline GFR and ERPF values.
Main Results:
- Baseline GFR and ERPF were lower in transplant recipients compared to controls.
- All groups showed significant increases in GFR and ERPF after protein load.
- Transplant recipients exhibited a preserved RFR GFR (23%) and a significantly higher RFR ERPF (35%) compared to controls.
Conclusions:
- Pediatric kidney transplant recipients on cyclosporine possess a significant renal functional reserve.
- RFR ERPF was notably higher in transplant recipients, suggesting adaptive mechanisms.
- Stimulated GFR and ERPF correlated with kidney length in transplant recipients.
Abstract:
Renal functional reserve (RFR) after an oral protein load was evaluated in 36 cyclosporine-treated children following kidney transplantation (Tx), in 15 kidney donors (Don), and in 15 children with single kidneys (Nx/Ag). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined by clearances of inulin (and creatinine) and para-aminohippurate during water diuresis. Baseline and stimulated GFR and ERPF were determined and RFR was calculated as the difference between stimulated and baseline values. Baseline GFR and ERPF in Tx were lower than in Don and Nx/Ag. Both GFR and ERPF increased significantly in all groups from baseline to stimulated values. RFR GFR was 23% +/- 3%, 20% +/- 3% and 15% +/- 3% in Tx, Don, and Nx/Ag and RFR ERPF 35% +/- 4% in Tx, which was significantly higher than 20% +/- 4% and 15% +/- 3% in the two other groups respectively. Stimulated GFR and ERPF in Tx correlated with kidney length. No differences were seen in recipient-donor pairs, except for higher fractional increases of ERPF in recipients. There was no correlation between RFR measured by clearance of creatinine and clearance of inulin. In conclusion, cyclosporine-treated children following renal Tx were found to have a renal reserve capacity.