Despite their selection on health, LKD have been found to have subclinical nephrosclerosis. Identifying pre-donation characteristics that predict nephrosclerosis is of critical importance. We evaluated metabolic abnormalities, kidney function, and blood pressure as predictors of nephrosclerosis in LKD.
Methods: We identified 289 donors between 2005 and 2012 in whom we assessed pre-donation measured GFR and renal histology on implant biopsy. 117/289 donors underwent monitoring of their residual kidney function at a median follow up of 289 days (180394 days) with 83 donors having also reached 749 days (4441357 days) of follow up. Nephrosclerosis was characterized by: a) >5% global glomerulosclerosis (GS), b) >5% interstitial fibrosis with tubular atrophy (IF/TA), and c) any arteriosclerosis. Total kidney volume (adjusted for BSA) was measured by multidetector computed tomography. Metabolic syndrome was defined using the modified NCEP-ATP III criteria.
Results: GS alone without IF/TA were present in 45 donors (15.6%), and IF/TA with or without GS was present in 22 (7.6%) donors. Any arteriosclerosis was present in 88 (30.4%) donors.
Compared to donors with normal histology, those with either GS or IF/TA were more likely to be older (mean 48 vs 40 years, p<0.001) and have metabolic syndrome (21% vs 9%, p=0.007). Donors with IF/TA had significant higher diastolic blood pressure (mean 77 vs. 73 mmHg, p=0.036) and significant lower iothalamate GFR (mean 99 vs 107 ml/min/1.73m2, p=0.024). LKD with any degree of arteriosclerosis were more likely to have smaller kidney volume (mean 322 vs 335 cc/1.73m2, p=0.028).
Percent decrease in eGFR at follow up was significantly higher in donors with IF/TA than donors with normal histology at implant (mean -38% vs -33%, p=0.034).
Conclusions: Aging and metabolic syndrome are associated with mild nephrosclerosis on renal biopsy at time of donation among relatively healthy LKD. This subclinical nephrosclerosis may contribute to smaller kidney size and lower functional reserve capacity after nephrectomy.
To cite this abstract in AMA style:Heaphy E, Ohashi Y, Nurko S, Stephany B, Fatica R, Amer H, Rule A, Schold J, Poggio E. Associations of Nephrosclerosis with Kidney Function and Size in Living Kidney Donors (LKD) [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/associations-of-nephrosclerosis-with-kidney-function-and-size-in-living-kidney-donors-lkd/. Accessed December 6, 2023.
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