title: Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study.
abstract: BACKGROUND
  In living kidney transplantation, preoperative donors' renal functional reserve (RFR) may correlate with postoperative residual renal function in both donors and recipients. The aim of this study was to evaluate the donors' RFR before transplantation and to compare basal and stress renal function before and after transplantation in both donors and recipients.
  
  
  METHODS
  Seven pairs of living kidney donors and recipients were considered for this observational study. RFR was measured with a renal stress test (RST) before and after the kidney transplantation through an oral protein loading test (1 g/kg of body weight). RFR was defined as the difference between the maximum value of creatinine clearance after protein load (stress glomerular filtration rate, sGFR) and baseline creatinine clearance (basal GFR, bGFR).
  
  
  RESULTS
  Before transplantation, a significant difference between sGFR and bGFR (p = 0.04) was observed in donors, with an RFR = 30.6 (11.9-41.5) mL/min/1.73 m2. After kidney transplantation, sGFR was similar to bGFR for both donors and recipients (p = 0.13), with a limited RFR (7.9 [6.70-19.25] and 14.90 [-6.67 to 25.53] mL/min/1.73 m2, respectively). The sum of the donor's and recipient's post-transplant sGFR was similar to the pre-transplant donor's sGFR (p = 0.73).
  
  
  CONCLUSIONS
  RST is a safe, feasible, easy, and an inexpensive tool that is able to quantify RFR. In living kidney transplantation, it can be used in clinical practice to measure the original global filtration capacity of the donor's kidneys (sGFR) and to quantify the susceptibility of donors and recipients in developing postoperative kidney dysfunction. However, further studies with an adequate sample size and follow-up period are needed to test this hypothesis.
authors.affiliation: International Renal Research Institute Vicenza (IRRIV), Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Spinelli
authors.forename: Aashish
authors.initials: A
authors.lastname: Sharma
authors.forename: Gianluca
authors.initials: G
authors.lastname: Villa
authors.forename: Sara
authors.initials: S
authors.lastname: Samoni
authors.forename: Francesco
authors.initials: F
authors.lastname: Ramponi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Brocca
authors.forename: Alessandra
authors.initials: A
authors.lastname: Brendolan
authors.forename: Stefano
authors.initials: S
authors.lastname: Chiaramonte
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Castellano
authors.forename: Loreto
authors.initials: L
authors.lastname: Gesualdo
authors.forename: Claudio
authors.initials: C
authors.lastname: Ronco
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000502:physiology* / Q000503:physiopathology; D007674:Kidney Diseases / Q000503:physiopathology / Q000601:surgery; D007677:Kidney Function Tests / Q000379:methods*; D016030:Kidney Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies
chemical_list: D003404:Creatinine