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Paradigm shift in lifestyle modification for solitary kidney after donor nephrectomy. Curr Opin Nephrol Hypertens 2023; 32:67-75. [PMID: 36444664 DOI: 10.1097/mnh.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Living donor kidney transplantation potentially leads to long-term complications including chronic kidney disease, end-stage kidney disease, elevated blood pressure, and pregnancy-associated hypertension. Given living donors generally do not have underlying medical conditions, lifestyle modifications, particularly dietary interventions may prevent those complications and improve their health outcomes. RECENT FINDINGS Glomerular hyperfiltration occurs as physiologic adaptation during an initial postdonor nephrectomy period. In the long-term, these adaptations may become pathologic consequences resulting from hyperfiltration-mediated kidney injury and ultimately secondary focal segmental glomerulosclerosis in the solitary kidney. Dietary interventions to slow a decline in kidney function include low protein intake of <0.8 g/kg/day and low sodium consumption of 2-4 g/day as well as certain health dietary patterns. There is no evidence regarding the quantity and quality of protein that can be recommended for living kidney donors and the same for sodium. Plant Dominant (PLADO) diets, Dietary Approaches to Stop Hypertension (DASH), Mediterranean, and vegetarian diets may be favorable for living kidney donors with solitary kidney but the evidence is still lacking. SUMMARY Although dietary interventions may provide benefits and kidney health for living kidney donors, further studies including clinical trials are required to incorporate them into clinical practice guidelines.
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Díaz-De la Cruz EN, Cerrillos-Gutiérrez JI, García-Sánchez A, Andrade-Sierra J, Cardona-Muñoz EG, Rojas-Campos E, González-Espinoza E, Miranda-Díaz AG. The Alteration of Pro-inflammatory Cytokines and Oxidative Stress Markers at Six-Month Post-living Kidney Donation. Front Med (Lausanne) 2020; 7:382. [PMID: 32850897 PMCID: PMC7403208 DOI: 10.3389/fmed.2020.00382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/19/2020] [Indexed: 12/02/2022] Open
Abstract
Donors have a higher risk of developing chronic kidney disease than the general population. Some mechanisms mediated by pro-inflammatory cytokines and oxidative stress may be involved as risk factors. The objective of the study was to evaluate the behavior of pro-inflammatory cytokines and oxidative stress markers in living renal donors with a 6-month follow-up. A single prospective cohort was performed in 88 renal donors. At the end of the follow-up, the levels of lipoperoxides, 6.52 ± 1.12 mM, and 8-isoprostanes, 63.75 ± 13.28 pg/mL, were lower than before donation, 10.20 ± 3.95 mM (p < 0.001) and 67.54 ± 9.64 pg/mL (p = 0.026), respectively. Initial levels of nitric oxide (NO), 356.09 ± 59.38 μM increased at the end of the follow-up, 467.08 ± 38.74 μM (p < 0.001). It was observed in the final determination of donors decreased activity of antioxidant enzymes superoxide dismutase (SOD), 0.74 ± 0.57 U/L and glutathione peroxidase (GPx), 556.41 ± 80.37 nmol, in comparison with the levels obtained in the initial determination, 1.05 ± 0.57 U/L (p < 0.001) and 827.93 ± 162.78 nmol (p < 0.001), respectively. The pro-inflammatory cytokines, Tumor necrosis factor alpha and interleukin-6 showed no differences at 6 months after donation. The enzyme oxoguanine glycosylase (hOGG1) responsible for repairing oxidative damage to DNA, showed a decrease in its concentration at the end of the study in donor men, 0.40 ± 0.21 ng/mL compared to the initial levels, 0.55 ± 0.32 ng/mL (p = 0.025). The marker, 8-hydroxy-2-deoxyguanosine (8-OHdG) exhibited an increase in donor men at the final determination 2.28 ± 1.99 ng/mL, compared to the concentration before donation, 1.72 ± 1.96 ng/mL (p < 0.001). We found significant changes in the markers of the oxidative state with increased NO and 8-OHdG, as well as a significant decrease in the antioxidant defenses SOD, GPx, and in the DNA repair enzyme in living renal donors after 6 months of follow-up.
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Affiliation(s)
- Elodia Nataly Díaz-De la Cruz
- Department of Physiology, Institute of Experimental and Clinical Therapeutics, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - José Ignacio Cerrillos-Gutiérrez
- Department of Nephrology and Transplants, Specialties Hospital, National Occidental Medical Centre, The Mexican Social Security Institute, Guadalajara, Mexico
| | - Andrés García-Sánchez
- Department of Physiology, Institute of Experimental and Clinical Therapeutics, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Jorge Andrade-Sierra
- Department of Nephrology and Transplants, Specialties Hospital, National Occidental Medical Centre, The Mexican Social Security Institute, Guadalajara, Mexico
| | - Ernesto Germán Cardona-Muñoz
- Department of Physiology, Institute of Experimental and Clinical Therapeutics, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Enrique Rojas-Campos
- Kidney Diseases Medical Research Unit, Specialties Hospital, National Occidental Medical Centre, Mexican Social Security Institute, Guadalajara, Mexico
| | - Eduardo González-Espinoza
- Department of Nephrology and Transplants, Specialties Hospital, National Occidental Medical Centre, The Mexican Social Security Institute, Guadalajara, Mexico
| | - Alejandra Guillermina Miranda-Díaz
- Department of Physiology, Institute of Experimental and Clinical Therapeutics, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
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