TY - JOUR
T1 - Kidney Microstructural Features at the Time of Donation Predict Long-term Risk of Chronic Kidney Disease in Living Kidney Donors
AU - Merzkani, Massini A.
AU - Denic, Aleksandar
AU - Narasimhan, Ramya
AU - Lopez, Camden L.
AU - Larson, Joseph J.
AU - Kremers, Walter K.
AU - Chakkera, Harini A.
AU - Park, Walter D.
AU - Taler, Sandra J.
AU - Stegall, Mark D.
AU - Alexander, Mariam P.
AU - Issa, Naim
AU - Rule, Andrew D.
N1 - Funding Information:
Grant Support: This study was supported with funding from the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases ( R01 DK090358 ). This study was supported by NIH T32 training grant 5T32DK007013. This publication was made possible by Clinical and Translational Science Awards grant number UL1 TR002377 from the National Center for Advancing Translational Sciences , a component of the NIH. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.
Publisher Copyright:
© 2020 Mayo Foundation for Medical Education and Research
PY - 2021/1
Y1 - 2021/1
N2 - Objective: To determine whether microstructural features on a kidney biopsy specimen obtained during kidney transplant surgery predict long-term risk of chronic kidney disease in the donor. Patients and Methods: We studied kidney donors from May 1, 1999, through December 31, 2018, with a follow-up survey for the results of recent blood pressure and kidney function tests (estimated glomerular filtration rate [eGFR] and proteinuria). If not recently available, blood pressure and eGFRs were requested from a local clinic. Microstructural features on kidney biopsy at the time of donation were assessed as predictors of hypertension and kidney function after adjusting for years of follow-up, baseline age, sex, and clinical predictors. Results: There were 807 donors surveyed a mean 10.5 years after donation. An eGFR less than 45 mL/min/1.73 m2 in 6.4% (43/673) of donors was predicted by larger glomerular volume per standard deviation (odds ratio [OR], 1.48; 95% CI, 1.08 to 2.04) and nephron number below the age-specific 5th percentile (OR, 3.38; 95% CI, 1.31 to 8.72). An eGFR less than 60 mL/min/1.73 m2 in 42.5% (286/673) of donors was not predicted by any microstructural feature. Residual eGFR (postdonation/predonation eGFR) was predicted by nephron number below the age-specific 5th percentile (difference, −6.07%; 95% CI, −10.24% to −1.89%). Self-reported proteinuria in 5.1% (40/786) of donors was predicted by larger glomerular volume (OR, 1.42; 95% CI, 1.08 to 1.86). Incident hypertension in 18.8% (119/633) of donors was not predicted by any microstructural features. Conclusion: Low nephron number for age and larger glomeruli are important microstructural predictors for long-term risk of chronic kidney disease after living kidney donation.
AB - Objective: To determine whether microstructural features on a kidney biopsy specimen obtained during kidney transplant surgery predict long-term risk of chronic kidney disease in the donor. Patients and Methods: We studied kidney donors from May 1, 1999, through December 31, 2018, with a follow-up survey for the results of recent blood pressure and kidney function tests (estimated glomerular filtration rate [eGFR] and proteinuria). If not recently available, blood pressure and eGFRs were requested from a local clinic. Microstructural features on kidney biopsy at the time of donation were assessed as predictors of hypertension and kidney function after adjusting for years of follow-up, baseline age, sex, and clinical predictors. Results: There were 807 donors surveyed a mean 10.5 years after donation. An eGFR less than 45 mL/min/1.73 m2 in 6.4% (43/673) of donors was predicted by larger glomerular volume per standard deviation (odds ratio [OR], 1.48; 95% CI, 1.08 to 2.04) and nephron number below the age-specific 5th percentile (OR, 3.38; 95% CI, 1.31 to 8.72). An eGFR less than 60 mL/min/1.73 m2 in 42.5% (286/673) of donors was not predicted by any microstructural feature. Residual eGFR (postdonation/predonation eGFR) was predicted by nephron number below the age-specific 5th percentile (difference, −6.07%; 95% CI, −10.24% to −1.89%). Self-reported proteinuria in 5.1% (40/786) of donors was predicted by larger glomerular volume (OR, 1.42; 95% CI, 1.08 to 1.86). Incident hypertension in 18.8% (119/633) of donors was not predicted by any microstructural features. Conclusion: Low nephron number for age and larger glomeruli are important microstructural predictors for long-term risk of chronic kidney disease after living kidney donation.
UR - http://www.scopus.com/inward/record.url?scp=85095441510&partnerID=8YFLogxK
U2 - 10.1016/j.mayocp.2020.08.041
DO - 10.1016/j.mayocp.2020.08.041
M3 - Article
C2 - 33097219
AN - SCOPUS:85095441510
SN - 0025-6196
VL - 96
SP - 40
EP - 51
JO - Mayo Clinic Proceedings
JF - Mayo Clinic Proceedings
IS - 1
ER -