title: The association of predonation hypertension with glomerular function and number in older living kidney donors.
abstract: The effect of preexisting hypertension on living donor nephron number has not been established. In this study, we determined the association between preexisting donor hypertension and glomerular number and volume and assessed the effect of predonation hypertension on postdonation BP, adaptive hyperfiltration, and compensatory glomerular hypertrophy. We enrolled 51 living donors to undergo physiologic, morphometric, and radiologic evaluations before and after kidney donation. To estimate the number of functioning glomeruli (NFG), we divided the whole-kidney ultrafiltration coefficient (Kf) by the single-nephron ultrafiltration coefficient (SNKf). Ten donors were hypertensive before donation. We found that, in donors ages >50 years old, preexisting hypertension was associated with a reduction in NFG. In a comparison of 10 age- and sex-matched hypertensive and normotensive donors, we observed more marked glomerulopenia in hypertensive donors (NFG per kidney, 359,499±128,929 versus 558,239±205,152; P=0.02). Glomerulopenia was associated with a nonsignificant reduction in GFR in the hypertensive group (89±12 versus 95±16 ml/min per 1.73 m(2)). We observed no difference in the corresponding magnitude of postdonation BP, hyperfiltration capacity, or compensatory renocortical hypertrophy between hypertensive and normotensive donors. Nevertheless, we propose that the greater magnitude of glomerulopenia in living kidney donors with preexisting hypertension justifies the need for long-term follow-up studies.
authors.affiliation: Division of Nephrology, Department of Medicine and.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Lenihan
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Stephan
authors.initials: S
authors.lastname: Busque
authors.affiliation: Division of Nephrology, Department of Medicine and.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Derby
authors.affiliation: Division of Nephrology, Department of Medicine and.
authors.forename: Kristina
authors.initials: K
authors.lastname: Blouch
authors.affiliation: Division of Nephrology, Department of Medicine and.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: Myers
authors.affiliation: Division of Nephrology, Department of Medicine and jane.tan@stanford.edu.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Tan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001795:Blood Pressure Determination; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods; D009399:Nephrons / Q000503:physiopathology*; D064266:Preexisting Condition Coverage; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
keywords: GFR; kidney donation; nephron