title: Urinary biomarkers after donor nephrectomy.
abstract: As the beginning of living-donor kidney transplantation, physicians have expressed concern about the possibility that unilateral nephrectomy can be harmful to a healthy individual. To investigate whether the elevated intra-abdominal pressure (IAP) during laparoscopic donor nephrectomy causes early damage to the remaining kidney, we evaluated urine biomarkers after laparoscopic donor nephrectomy. We measured albumin and alpha-1-microglobulin (α-1-MGB) in urine samples collected during and after open and laparoscopic donor nephrectomy and laparoscopic cholecystectomy and colectomy. Additionally, kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) were measured in urine samples collected during and after laparoscopic donor nephrectomy and colectomy. The same biomarkers were studied in patients randomly assigned to standard or low IAP during laparoscopic donor nephrectomy. We observed a peak in urinary albumin excretion during all procedures. Urine α-1-MGB rose in the postoperative period with a peak on the third postoperative day after donor nephrectomy. Urine α-1-MGB did not increase after laparoscopic cholecystectomy and colectomy. After laparoscopic nephrectomy, we observed slight increases in urine KIM-1 during surgery and in urine NGAL at day 2-3 after the procedure. After laparoscopic colectomy, both KIM-1 and NGAL were increased in the postoperative period. There were no differences between the high- and low-pressure procedure. Elevated urinary α-1-MGB suggests kidney damage after donor nephrectomy, occurring irrespective of IAP during the laparoscopic procedure.
authors.affiliation: Department of Nephrology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands; Department of Nephrology, Isala Zwolle, Zwolle, The Netherlands.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Hoogendijk-van den Akker
authors.forename: Michiel C
authors.initials: MC
authors.lastname: Warlé
authors.forename: Arjan D
authors.initials: AD
authors.lastname: van Zuilen
authors.forename: Heinrich J
authors.initials: HJ
authors.lastname: Kloke
authors.forename: Kim E
authors.initials: KE
authors.lastname: Wever
authors.forename: Frank C H
authors.initials: FC
authors.lastname: d'Ancona
authors.forename: Denise M D
authors.initials: DM
authors.lastname: Ӧzdemir
authors.forename: Jack F M
authors.initials: JF
authors.lastname: Wetzels
authors.forename: Andries J
authors.initials: AJ
authors.lastname: Hoitsma
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine; D000328:Adult; D000368:Aged; D000418:Albumins / Q000737:chemistry; D000510:Alpha-Globulins / Q000652:urine*; D015415:Biomarkers / Q000652:urine*; D017081:Cholecystectomy, Laparoscopic; D003082:Colectomy; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007668:Kidney / Q000601:surgery; D010535:Laparoscopy; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine; D019520:Living Donors; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine; D008875:Middle Aged; D009392:Nephrectomy; D011184:Postoperative Period; D011312:Pressure; D011518:Proto-Oncogene Proteins / Q000652:urine; D011991:Receptors, Virus; D013997:Time Factors; D016896:Treatment Outcome; D062885:Urinary Catheters
chemical_list: D000209:Acute-Phase Proteins; D000418:Albumins; D000510:Alpha-Globulins; D015415:Biomarkers; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D008562:Membrane Glycoproteins; D011518:Proto-Oncogene Proteins; D011991:Receptors, Virus; C016001:alpha-1-microglobulin; D003404:Creatinine
keywords: acute kidney injury; donor nephrectomy; urinary biomarkers