1
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Ito T, Kenmochi T, Kurihara K, Aida N, Hasegawa M, Ishihara T, Shintani A. Age and Pre-operative HbA1c levels affect renal function compensation in living kidney donors. Int Urol Nephrol 2024; 56:1315-1322. [PMID: 38032440 DOI: 10.1007/s11255-023-03877-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES About 90% of Japanese kidney transplantations are conducted from living donors, and their safety and the maintenance of their renal function are critical. This study aims to identify factors that affect the compensation of renal function in living kidney donors after donor nephrectomy. METHOD In a retrospective cohort study, we reviewed data from 120 patients who underwent nephrectomy as living kidney transplant donors in our department from 2012 to 2021. Univariable and multivariable linear regression analyses were performed for donor factors affecting renal function after donor nephrectomy. RESULT The multivariable linear regression model revealed that the donor's age (p = 0.025), preoperative estimated Glomerular Filtration Rate (eGFR) (p < 0.001), and hemoglobin A1c (HbA1c) (p = 0.043) were independent risk factors for eGFR at six months after nephrectomy. The eGFR deterioration was more strongly associated with age in females than in males, whereas higher HbA1c values were more strongly associated with eGFR deterioration in males. Higher donor age and higher HbA1c each enhance the deterioration of eGFR six months after living donor nephrectomy. The data suggest that old age in especially female donors and preoperative higher HbA1c in male donors have a harmful impact on their renal function compensation.
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Affiliation(s)
- Taihei Ito
- Department of Transplantation and Regenerative Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan.
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Kei Kurihara
- Department of Transplantation and Regenerative Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Naohiro Aida
- Department of Transplantation and Regenerative Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo Kutsukake-Cho, Toyoake, Aichi, 470-1192, Japan
| | - Midori Hasegawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu University, Gifu, Gifu, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan
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2
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Adebayo OC, Nkoy AB, van den Heuvel LP, Labarque V, Levtchenko E, Delanaye P, Pottel H. Glomerular hyperfiltration: part 2-clinical significance in children. Pediatr Nephrol 2022:10.1007/s00467-022-05826-5. [PMID: 36472656 DOI: 10.1007/s00467-022-05826-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/27/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Abstract
Glomerular hyperfiltration (GHF) is a phenomenon that can occur in various clinical conditions affecting the kidneys such as sickle cell disease, diabetes mellitus, autosomal dominant polycystic kidney disease, and solitary functioning kidney. Yet, the pathophysiological mechanisms vary from one disease to another and are not well understood. More so, it has been demonstrated that GHF may occur at the single-nephron in some clinical conditions while in others at the whole-kidney level. In this review, we explore the pathophysiological mechanisms of GHF in relation to various clinical conditions in the pediatric population. In addition, we discuss the role and mechanism of action of important factors such as gender, low birth weight, and race in the pathogenesis of GHF. Finally, in this current review, we further highlight the consequences of GHF in the progression of kidney disease.
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Affiliation(s)
- Oyindamola C Adebayo
- Center of Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
| | - Agathe B Nkoy
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Division of Nephrology, Department of Pediatrics, Faculty of Medicine, University Hospital of Kinshasa, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Lambertus P van den Heuvel
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Nephrology, Radboud University Medical Centre, 6500 Nijmegen, The Netherlands
| | - Veerle Labarque
- Center of Vascular and Molecular Biology, Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Elena Levtchenko
- Laboratory of Pediatric Nephrology, Department of Development and Regeneration, Katholieke Universiteit Leuven, Campus Gasthiusberg, 3000 Leuven, Belgium
- Department of Pediatric Nephrology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium
- Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Hans Pottel
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Campus Kulak, 8500 Kortrijk, Belgium.
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3
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Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, Moral JLLD, Musquera M, Paredes D, Redondo D, Revuelta I, Hofstadt CJVD, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Recommendations for living donor kidney transplantation. Nefrologia 2022; 42 Suppl 2:5-132. [PMID: 36503720 DOI: 10.1016/j.nefroe.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023] Open
Abstract
This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.
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Affiliation(s)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Juana Alonso
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Esther González
- Nephrology Department, Hospital Universitario 12 Octubre, Spain
| | | | - Lluis Guirado
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | - Jorge Huguet
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | | | - Mireia Musquera
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | - David Paredes
- Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Ignacio Revuelta
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Antonio Alcaraz
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Manuel Alonso
- Regional Transplantation Coordination, Seville, Spain
| | | | - Gabriel Bernal
- Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alberto Breda
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | - Mercedes Cabello
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Joan Cid
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Laura Espinosa
- Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain
| | - Carme Facundo
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | - Miquel Lozano
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | | | - Eduard Palou
- Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain
| | | | - Lluis Peri
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain.
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4
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Matas AJ, Rule AD. Long-term Medical Outcomes of Living Kidney Donors. Mayo Clin Proc 2022; 97:2107-2122. [PMID: 36216599 PMCID: PMC9747133 DOI: 10.1016/j.mayocp.2022.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022]
Abstract
Historically, to minimize risks, living kidney donors have been highly selected and healthy. Operative risks are well-defined, yet concern remains about long-term risks. In the general population, even a mild reduction in glomerular filtration rate (GFR) is associated with cardiovascular disease, chronic kidney disease, and end-stage kidney disease (ESKD). However, reduction in GFR in the general population is due to kidney or systemic disease. Retrospective studies comparing donors with matched general population controls have found no increased donor risk. Prospective studies comparing donors with controls (maximum follow-up, 9 years) have reported that donor GFR is stable or increases slightly, whereas GFR decreases in controls. However, these same studies identified metabolic and vascular donor abnormalities. There are a few retrospective studies comparing donors with controls. Each has limitations in selection of the control group, statistical analyses, and/or length of follow-up. One such study reported increased donor mortality; 2 reported a small increase in absolute risk of ESKD. Risk factors for donor ESKD are similar to those in the general population. Postdonation pregnancies are also associated with increased risk of hypertension and preeclampsia. There is a critical need for long-term follow-up studies comparing donors with controls from the same era, geographic area, and socioeconomic status who are healthy, with normal renal function on the date matching the date of donation, and are matched on demographic characteristics with the donors. These data are needed to optimize donor candidate counseling and informed consent.
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Affiliation(s)
- Arthur J Matas
- Transplantation Division, Department of Surgery, University of Minnesota, Minneapolis.
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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5
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Saiki R, Katayama K, Kitano M, Tsujimoto K, Tanaka F, Suzuki Y, Murata T, Kurita T, Okamoto R, Takeuchi K, Dohi K. A Perihilar Variant of Focal Segmental Glomerulosclerosis Due to De novo Branchio-oto-renal Syndrome. Intern Med 2022; 61:2033-2038. [PMID: 34866102 PMCID: PMC9334246 DOI: 10.2169/internalmedicine.8508-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Branchio-oto-renal syndrome is an autosomal dominant disorder characterized by branchial anomalies, hearing loss, and renal urinary tract malformations. We herein report a 32-year-old Japanese man with a right preauricular pit, bilateral mixed hearing loss, and malposition of the right kidney who presented with proteinuria. The findings of a left kidney biopsy were compatible with a perihilar variant of secondary focal segmental glomerular sclerosis. A trio exome analysis conducted among the patient and his parents failed to identify the causal gene variant, despite a sporadic pattern. His kidney function remained stable for 11 years with an angiotensin II receptor blocker.
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Affiliation(s)
- Ryosuke Saiki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Kan Katayama
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Masako Kitano
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Japan
| | - Kayo Tsujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Fumika Tanaka
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Yasuo Suzuki
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Tomohiro Murata
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Ryuji Okamoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
| | - Kazuhiko Takeuchi
- Department of Otorhinolaryngology-Head & Neck Surgery, Mie University Graduate School of Medicine, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Japan
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6
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Recomendaciones para el trasplante renal de donante vivo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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7
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Keys DO, Jackson S, Berglund D, Matas AJ. Kidney donor outcomes ≥ 50 years after donation. Clin Transplant 2019; 33:e13657. [PMID: 31283043 DOI: 10.1111/ctr.13657] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 07/01/2019] [Indexed: 01/10/2023]
Abstract
Many living kidney donors (LDs) are young at donation; yet there are little data on long-term LD follow-up. We report on 66 LDs who donated ≥50 years ago: 22 (33.3%) are still alive (current age, 78.5 ± 7.25 years); 39 (59%) died (mean age at death, 74.2 ± 12.3 years); and 5 are lost to follow-up (mean age at last contact, 68.7 ± 4.6 years). Those who died were older at donation (P < .001). Causes of death included 12 (30.8% of deaths) cardiovascular diseases, 9 (23.0%) respiratory failures, 5 (12.8%) malignancies and 4 (10.3%) infections, and 9 (23%) were unknown or miscellaneous. Forty-nine living donors (74%) developed hypertension at a mean age of 59.9 ± 14.0 years; 12 (18%) developed diabetes at a mean age of 62 ± 19.4 years; and 11 (16.7%) developed proteinuria at a mean age of 60.6 ± 18.2 years-each at a similar incidence as seen in the age-matched general population. At last follow-up, the eGFR by CKD-EPI (mean ± SD) for donors currently alive was 60.2 ± 13.4 mL/min/1.73 m2 ; for those that died, 54.0 ± 21.5 mL/min/1.73 m2 ; for those lost to follow-up, 55.6 ± 7.5 mL/min/1.73 m2 . ESRD developed in 2 (3.3%). SF-36 quality of life health survey scores (n = 21) were similar to the age-matched general population.
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Affiliation(s)
- Daniel O Keys
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Scott Jackson
- Informatics Services for Researching & Reporting, Fairview, Minneapolis, Minnesota
| | - Danielle Berglund
- Informatics Services for Researching & Reporting, Fairview, Minneapolis, Minnesota
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
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8
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Kim S, Chang Y, Lee YR, Jung HS, Hyun YY, Lee KB, Joo KJ, Yun KE, Shin H, Ryu S. Solitary kidney and risk of chronic kidney disease. Eur J Epidemiol 2019; 34:879-888. [PMID: 31025238 DOI: 10.1007/s10654-019-00520-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/13/2019] [Indexed: 01/10/2023]
Abstract
The renal outcome of solitary kidney remains controversial. We examined the longitudinal association of congenital or acquired solitary kidney with the development of chronic kidney disease (CKD). A cohort study was performed involving 271,171 Korean men and women free of CKD at baseline who underwent a health screening program and who were followed annually or biennially for an average of 5.4 years. Solitary kidney was determined based on ultrasonographic findings. CKD was defined as an estimated glomerular filtration rate of < 60 ml/min/1.73 m2 and/or the presence of proteinuria in two or more consecutive visits. During 1,472,519.6 person-years of follow-up, 2989 participants developed CKD (incidence rate: 2.0 per 1000 person-years). After adjustment for potential confounders, the aHR (95% CIs) for incident CKD comparing solitary kidney to the control was 3.26 (1.63-6.54). In analyses of cause-specific solitary kidney, aHR (95% CIs) for CKD comparing unilateral nephrectomy and congenital solitary kidney to the control were 6.18 (2.31-16.49) and 2.22 (0.83-5.92), respectively. The association between solitary kidney and CKD was stronger in men. Having a solitary kidney was independently associated with an increased risk of CKD development. Therefore, preventive strategies for reducing the risk of CKD are required in individuals with a solitary kidney.
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Affiliation(s)
- Seolhye Kim
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yoosoo Chang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul, 04514, South Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Young Rae Lee
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyun-Suk Jung
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Youl Hyun
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyu-Beck Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kwan Joong Joo
- Department of Urology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung Eun Yun
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hocheol Shin
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seungho Ryu
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Samsung Main Building B2, 250, Taepyung-ro 2ga, Jung-gu, Seoul, 04514, South Korea.
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
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9
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Mjoen G, Abramowicz D. What happens to the live donor in the years following donation? Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Geir Mjoen
- Division of Medicine, Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Daniel Abramowicz
- Department of Nephrology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
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10
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Caglayan V, Oner S, Onen E, Avci S, Aydos M, Kilic M, Demirbas M. Percutaneous nephrolithotomy in solitary kidneys: effective, safe and improves renal functions. MINERVA UROL NEFROL 2018; 70:518-525. [DOI: 10.23736/s0393-2249.18.03123-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Thukral S, Mazumdar A, Ray DS. Long-Term Consequences of Complex Living Renal Donation: Is It Safe? Transplant Proc 2018; 50:3185-3191. [PMID: 30340774 DOI: 10.1016/j.transproceed.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION As there is a paucity of literature regarding the long-term outcomes of complex living donors, we conducted this study to assess the effect of kidney donation on the complex living kidney donor. MATERIALS AND METHODS This retrospective study was conducted in Narayan Health Hospital, Kolkata, Eastern India. The cohort consisted of complex living kidney donors who donated kidneys between the years 2007 and 2012. All donors were 60 years old or older, or were younger than 60 years and had comorbidities like hypertension and obesity. After a minimum follow-up of 5 years, all donors underwent evaluation. Data pertaining to hypertension, new-onset diabetes, body mass index (BMI), estimated glomerular filtration rate (eGFR) and albuminuria, and cardiac events were compared from the time of donation till 5 years post-transplant. RESULTS AND DISCUSSION We found a statistically significant increase in blood pressure, number of antihypertensives used, and mean BMI at follow-up. Diabetes mellitus was developed in 22.3% of donors. The mean GFR also decreased significantly at follow-up. There were 42 elderly donors (≥60 years) and 23 ≤ 59 years of age. There was a significant fall of eGFR in both groups, but the percentage fall was similar in both groups. A significant percentage of donors developed proteinuria, the majority being hypertensives. CONCLUSION Procurement of kidneys from marginal donors should be done cautiously, and donors should be assessed for morbidity and mortality in the future, as we found a statistically significant deterioration in renal function, blood pressure, and BMI over long-term follow-up.
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Affiliation(s)
- S Thukral
- Narayana Health Hospital, Mukundapur, Kolkata, India
| | - A Mazumdar
- Narayana Health Hospital, Mukundapur, Kolkata, India
| | - D S Ray
- Narayana Health Hospital, Mukundapur, Kolkata, India.
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12
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Maggiore U, Budde K, Heemann U, Hilbrands L, Oberbauer R, Oniscu GC, Pascual J, Schwartz Sorensen S, Viklicky O, Abramowicz D. Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group. Nephrol Dial Transplant 2018; 32:216-223. [PMID: 28186535 DOI: 10.1093/ndt/gfw429] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
Two recent matched cohort studies from the USA and Norway published in 2014 have raised some concerns related to the long-term safety of kidney living donation. Further studies on the long-term risks of living donation have since been published. In this position paper, Developing Education Science and Care for Renal Transplantation in European States (DESCARTES) board members critically review the literature in an effort to summarize the current knowledge concerning long-term risks of kidney living donation to help physicians for decision-making purposes and for providing information to the prospective live donors. Long-term risk of end-stage renal disease (ESRD) can be partially foreseen by trying to identify donors at risk of developing ‘de novo’ kidney diseases during life post-donation and by predicting lifetime ESRD risk. However, lifetime risk may be difficult to assess in young donors, especially in those having first-degree relatives with ESRD. The study from Norway also found an increased risk of death after living donor nephrectomy, which became visible only after >15 years of post-donation follow-up. However, these findings are likely to be largely the result of an overestimation due to the confounding effect related to a family history of renal disease. DESCARTES board members emphasize the importance of optimal risk–benefit assessment and proper information to the prospective donor, which should also include recommendations on health-promoting behaviour post-donation.
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Affiliation(s)
- Umberto Maggiore
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Klemens Budde
- Department of Nephrology, Charité Medical University Berlin, Berlin, Germany
| | - Uwe Heemann
- Department of Nephrology, Technical University of Munich, Munich, Germany
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Gabriel C Oniscu
- Transplant Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
| | | | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
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Kesimci E, Erkilic E, Kilinc I, Kilic M. Is an 87-Year-Old Grandfather Too Marginal for Being a Kidney Donor? The View of Anesthesiologists. J Clin Med Res 2016; 8:680-2. [PMID: 27540444 PMCID: PMC4974840 DOI: 10.14740/jocmr2629w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 12/03/2022] Open
Abstract
Living kidney donation has been accepted increasingly as a result of growth in the number of end-stage renal disease patients awaiting organ. In this aspect using grafts from marginal donors such as with advanced age is increasing in worldwide practice and also in Turkey. Therefore, anesthetic management of donors is particularly important. We herein report the anesthetic management of an 87-year-old grandfather donating his kidney to her granddaughter and review the current anesthetic strategies in a geriatric patient.
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Affiliation(s)
- Elvin Kesimci
- Anesthesiology and Reanimation Department, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Ezgi Erkilic
- Anesthesiology and Reanimation Department, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Ibrahim Kilinc
- General Surgery Department, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Mehmet Kilic
- General Surgery Department, Faculty of Medicine, University of Yildirim Beyazit, Ankara, Turkey
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Verma S, Yadav SS, Tomar V, Vyas N, Agarwal N, Sharma U. Deterioration in the renal function and risk of microalbuminuria after radical, simple and donor nephrectomy: A long-term outcome. Urol Ann 2016; 8:184-8. [PMID: 27141189 PMCID: PMC4839236 DOI: 10.4103/0974-7796.164854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives: Evaluation of deterioration in renal function and risk of micro albuminuria after radical, simple and donor nephrectomy. Materials and Methods: A total of 594 patients underwent nephrectomy (159 radical, 318 simple and 117 donors) from February 2009 to December 2012 in our institute. First 300 eligible patients were divided in 3 groups, each having equalled number of patients. Group 1 was consisted of patients who underwent radical, group 2 had simple and group 3 had donor nephrectomy. These patients were followed up to February 2015. Follow up of all the patients were done at first month following the surgery and then in every six months subsequently. The follow up included the measurement of serum creatinine and urinary micro albumin in a spot urine sample. CKD-EPI equation was used for calculation of e GFR. Results: At the end of our study, 35 patients (41.6%) in group 1 and 8 patients (8.69%) in group 2 developed CKD stage 3. During the follow-up period, 41% patients in group 1, 13% in group 2 and 4% in group 3 developed MA. Conclusion: Nephron-sparing surgery should be the standard treatment of renal tumors, wherever possible. There should be a regular follow up of the patients after radical, simple and donor nephrectomy because of risk of CKD. Early consultation with nephrologists should be done by the patients who are suffering from MA after nephrectomy.
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Affiliation(s)
- Shashi Verma
- Department of Urology and Renal Transplantation, SMS Medical College and Associated Hospitals, Jaipur, Rajasthan, India
| | - Sher Singh Yadav
- Department of Urology and Renal Transplantation, SMS Medical College and Associated Hospitals, Jaipur, Rajasthan, India
| | - Vinay Tomar
- Department of Urology and Renal Transplantation, SMS Medical College and Associated Hospitals, Jaipur, Rajasthan, India
| | - Nachiket Vyas
- Department of Urology and Renal Transplantation, SMS Medical College and Associated Hospitals, Jaipur, Rajasthan, India
| | - Neeraj Agarwal
- Department of Urology and Renal Transplantation, SMS Medical College and Associated Hospitals, Jaipur, Rajasthan, India
| | - Umesh Sharma
- Department of Urology and Renal Transplantation, SMS Medical College and Associated Hospitals, Jaipur, Rajasthan, India
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16
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Kuroda S, Fujikawa A, Tabei T, Ito H, Terao H, Yao M, Matsuzaki J. Retrograde intrarenal surgery for urinary stone disease in patients with solitary kidney: A retrospective analysis of the efficacy and safety. Int J Urol 2015; 23:69-73. [PMID: 26450647 DOI: 10.1111/iju.12951] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 08/23/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare outcomes of retrograde intrarenal surgery for urolithiasis between patients with solitary kidneys and patients who have single-side urolithiasis with bilateral kidneys. METHODS We retrospectively analyzed outcomes of retrograde intrarenal surgery in solitary kidney patients (group A) carried out during 2007-2014, and in patients with bilateral kidneys with comparable stone burdens (group B). Stone-free status was defined as no residual fragment on computed tomography 1 month later. RESULTS There were 19 patients in group A (mean age 62.5 ± 18.4 years, range 14-76 years). The mean stone diameter and burden were 6.0 mm (range 3-24 mm) and 10.42 ± 6.92 mm, respectively. The stone-free rate was 94.7%, and no repeat procedure was required. The glomerular filtration rate tended to rise post-surgery (postoperative day 1: 48.67 ± 15.92 mL/min, 100.2%, P = 0.940; postoperative month 1: 51.32 ± 16.90 mL/min, 105.7%, P = 0.101) compared with preoperative rates. The stone-free rate and surgery time were not significantly different between the two groups, although post-surgical hospitalization time was longer for group A (4.05 vs 3.08 days, P = 0.037). The change in glomerular filtration rate was not significantly different between groups A and B (postoperative day 1: +0.101 vs +0.547 mL/min, respectively, P = 0.857; postoperative month 1: +2.749 vs 3.161 mL/min, respectively, P = 0.882). No significant difference was found in terms of complication rate. CONCLUSIONS Retrograde intrarenal surgery in solitary kidney patients is as safe and effective as in bilateral kidney patients.
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Affiliation(s)
- Shinnosuke Kuroda
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Atsushi Fujikawa
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Tadashi Tabei
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Hiroki Ito
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan.,Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Hideyuki Terao
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Hospital, Yokohama, Kanagawa, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi Higashi General Hospital, Yokohama, Kanagawa, Japan
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17
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Abstract
Low birth weight serves as a crude proxy for impaired growth during fetal life and indicates a failure for the fetus to achieve its full growth potential. Low birth weight can occur in response to numerous etiologies that include complications during pregnancy, poor prenatal care, parental smoking, maternal alcohol consumption, or stress. Numerous epidemiological and experimental studies demonstrate that birth weight is inversely associated with blood pressure and coronary heart disease. Sex and age impact the developmental programming of hypertension. In addition, impaired growth during fetal life also programs enhanced vulnerability to a secondary insult. Macrosomia, which occurs in response to maternal obesity, diabetes, and excessive weight gain during gestation, is also associated with increased cardiovascular risk. Yet, the exact mechanisms that permanently change the structure, physiology, and endocrine health of an individual across their lifespan following altered growth during fetal life are not entirely clear. Transmission of increased risk from one generation to the next in the absence of an additional prenatal insult indicates an important role for epigenetic processes. Experimental studies also indicate that the sympathetic nervous system, the renin angiotensin system, increased production of oxidative stress, and increased endothelin play an important role in the developmental programming of blood pressure in later life. Thus, this review will highlight how adverse influences during fetal life and early development program an increased risk for cardiovascular disease including high blood pressure and provide an overview of the underlying mechanisms that contribute to the fetal origins of cardiovascular pathology.
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Affiliation(s)
- Barbara T Alexander
- Department of Physiology and Biophysics, Women's Health Research Center, Center for Cardiovascular-Renal Research, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Fesler P, Mourad G, du Cailar G, Ribstein J, Mimran A. Arterial stiffness: an independent determinant of adaptive glomerular hyperfiltration after kidney donation. Am J Physiol Renal Physiol 2015; 308:F567-71. [PMID: 25568135 DOI: 10.1152/ajprenal.00524.2014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
After kidney donation, the remaining kidney tends to hyperfiltrate, thus limiting the initial loss of renal function. The potential determinants of this adaptive glomerular hyperfiltration (GHF) and specifically the influence of arterial function are poorly known. In 45 normotensive healthy kidney donors [51 ± 10 yr (mean ± SD), 39 females], glomerular filtration rate (GFR) was measured as the clearance of continuously infused (99m)Tc-DTPA and timed urine collections at baseline, i.e., before donation, and 1 yr after donation. GHF was computed as postdonation GFR minus half of baseline GFR. Arterial function was assessed as baseline carotid-femoral pulse wave velocity (PWV) and carotid augmentation index (AIx). After kidney donation, no significant change in blood pressure (BP) was observed, but two subjects developed hypertension. GFR decreased from 107 ± 19 to 73 ± 15 ml·min(-1)·1.73 m(-2), and mean GHF was 20 ± 10 ml·min(-1)·1.73 m(-2). In univariate analysis, GHF was inversely correlated to age (r(2) = 0.24, P = 0.01), baseline PWV (r(2) = 0.23, P = 0.001), and Aix (r(2) = 0.11, P = 0.031). Nevertheless, GHF was not correlated to baseline peripheral or central BP. In multivariate analysis, baseline PWV, but not AIx, remained inversely correlated to GHF, independently of age, baseline mean BP, and GFR (model r(2) = 0.34, P < 0.001). In healthy subjects selected for renal donation, increased arterial stiffness is associated with decreased postdonation compensatory hyperfiltration.
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Affiliation(s)
- Pierre Fesler
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France; Université Montpellier 1, Montpellier, France
| | - Georges Mourad
- Department of Nephrology, Hôpital Lapeyronie, Montpellier, France; and Université Montpellier 1, Montpellier, France
| | - Guilhem du Cailar
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France
| | - Jean Ribstein
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France; Université Montpellier 1, Montpellier, France
| | - Albert Mimran
- Department of Internal Medicine, Hopital Lapeyronie, Montpellier, France; Université Montpellier 1, Montpellier, France
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Daugherty M, Bratslavsky G. Compared with radical nephrectomy, nephron-sparing surgery offers a long-term survival advantage in patients between the ages of 20 and 44 years with renal cell carcinomas (≤4cm): An analysis of the SEER database. Urol Oncol 2014; 32:549-54. [DOI: 10.1016/j.urolonc.2013.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 11/18/2013] [Accepted: 11/19/2013] [Indexed: 01/29/2023]
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20
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Ferreira-Hermosillo A, Valdez-Martínez E, Bedolla M. Ethical issues relating to renal transplantation from prediabetic living donor. BMC Med Ethics 2014; 15:45. [PMID: 24935278 PMCID: PMC4065609 DOI: 10.1186/1472-6939-15-45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 06/09/2014] [Indexed: 12/04/2022] Open
Abstract
Background In Mexico, diabetes mellitus is the main cause of end − stage kidney disease, and some patients may be transplant candidates. Organ supply is limited because of cultural issues. And, there is a lack of standardized clinical guidelines regarding organ donation. These issues highlight the tension surrounding the fact that living donors are being selected despite being prediabetic. This article presents, examines and discusses using the principles of non-maleficience, autonomy, justice and the constitutionally guaranteed right to health, the ethical considerations that arise from considering a prediabetic person as a potential kidney donor. Discussion Diabetes is an absolute contraindication for donating a kidney. However, the transplant protocols most frequently used in Mexico do not consider prediabetes as exclusion criteria. In prediabetic persons there are well known metabolic alterations that may compromise the long − term outcomes of the transplant if such donors are accepted. Even so, many of them are finally included because there are not enough donor candidates. Both, families and hospitals face the need to rapidly accept prediabetic donors before the clinical conditions of the recipient and the evolution of the disease exclude him/her as a transplant candidate; however, when using a kidney potentially damaged by prediabetes, neither the donor’s nor the recipient’s long term health is usually considered. Considering the ethical implication as well as the clinical and epidemiological evidence, we conclude that prediabetic persons are not suitable candidates for kidney donation. This recommendation should be taken into consideration by Mexican health institutions who should rewrite their transplant protocols. Summary We argue that the decision to use a kidney from a living donor known to be pre-diabetic or from those persons with family history of T2DM, obesity, hypertension, or renal failure, should be considered unethical in Mexico if the donor bases the decision to donate on socially acceptable norms rather than informed consent as understood in modern medicine.
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Affiliation(s)
- Aldo Ferreira-Hermosillo
- Unidad de Investigación en Endocrinología Experimental, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Cuauhtémoc 330, colonia Doctores, 06729 Mexico City, Mexico.
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21
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MacDonald D, Kukla AK, Ake S, Berglund D, Jackson S, Issa N, Spong R, Matas AJ, Ibrahim HN. Medical outcomes of adolescent live kidney donors. Pediatr Transplant 2014; 18:336-41. [PMID: 24646177 DOI: 10.1111/petr.12238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/30/2022]
Abstract
Living kidney donation from donors <18 yr of age is uncommon. The majority of donations from adolescents took place several decades ago providing a unique opportunity to study true long-term consequences of donation. We compared survival, renal outcomes, and rates of hypertension and diabetes among 42 adolescent donors and matched older controls. Adolescent donors were matched with donors 18-30 yr on the following: gender, relation to the recipient, BMI at donation, eGFR at donation, and year of donation. After a mean follow-up of 31.8 ± 8.0 yr, 94.9% of adolescent donors were alive vs. 93.8% of controls. There was no significant difference in having eGFR (MDRD) <60 mL/min/1.73 m(2) (26.1% vs. 40.9%), hypertension (35.9% vs. 39.4%), diabetes (5.1% vs. 12.5%), or proteinuria (15.4% vs. 14.1%): adolescent donors vs. controls for all comparisons. These data suggest that adolescent donors are not at a higher risk of shortened survival, hypertension, diabetes, or proteinuria. Nevertheless, they probably should donate only when other options are exhausted as they have to live with a single kidney for decades and longer follow-up is needed.
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Affiliation(s)
- David MacDonald
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN, USA
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22
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Comparison of the laparoscopic versus open live donor nephrectomy: an overview of surgical complications and outcome. Langenbecks Arch Surg 2014; 399:543-51. [DOI: 10.1007/s00423-014-1196-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 04/14/2014] [Indexed: 01/10/2023]
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23
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ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant 2014; 28 Suppl 2:ii1-71. [PMID: 24026881 DOI: 10.1093/ndt/gft218] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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24
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Bergen CR, Reese PP, Collins D. Nutrition assessment and counseling of the medically complex live kidney donor. Nutr Clin Pract 2014; 29:207-14. [PMID: 24523133 DOI: 10.1177/0884533613520566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Kidney transplantation is the preferred option for patients with end-stage renal disease facing the need for dialysis because it provides maximum survival benefit. The number of people seeking kidney transplantation greatly exceeds available deceased donor organs. Organs from live donors provide a survival advantage over organs from deceased donors while also broadening the pool of available organs. The purpose of this review is to discuss the clinical guidelines that pertain to live kidney organ donation and to describe the nutrition evaluation and care of live kidney donors. The process for living kidney donation is dictated by policies centered on protecting the donor. In a perfect world, the living donor would present with a flawless medical examination and a benign family health history. The obesity epidemic has emerged as a major health concern. Live donor programs are faced with evaluating increasing numbers of obese candidates. These "medically complex donors" may present with obesity and its associated comorbid conditions, including hypertension, impaired glycemic control, and kidney stone disease. The dietitian's role in the live donor program is not well defined. Participation in the living donor selection meeting, where details of the evaluation are summarized, provides a platform for risk stratification and identification of donors who are at increased lifetime risk for poor personal health outcomes. Guiding the donor toward maintenance of a healthy weight through diet and lifestyle choices is a legitimate goal to minimize future health risks.
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Affiliation(s)
- Carol R Bergen
- Carol R. Bergen, CSR, LDN, Hospital of the University of Pennsylvania, Clinical Nutrition Support Service, 1910 Penn Tower, Philadelphia, PA 19104, USA.
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25
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Matas AJ, Ibrahim HN. The unjustified classification of kidney donors as patients with CKD: critique and recommendations. Clin J Am Soc Nephrol 2013; 8:1406-13. [PMID: 23813555 PMCID: PMC3731898 DOI: 10.2215/cjn.02110213] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Unilateral nephrectomy for kidney donation results in loss of about 30% of baseline GFR, leaving some donors with GFR <60 ml/min per 1.73 m(2), the threshold for the diagnosis CKD. This has resulted in insurability problems for some donors. This article reviews the definition of CKD, risks associated with CKD, and large follow-up studies on the vital status and risk of ESRD in kidney donors. It also provides evidence that kidney donors, despite having reduced GFR, are not at increased risk for CKD-associated morbidity and mortality. Epidemiologic studies, most with follow-up <10 years, have shown an association between GFR <60 ml/min per 1.73 m(2) and higher mortality and progression to ESRD. Low GFR in the absence of any other markers for kidney disease, however, conveys attenuated or minimal risk. Of note, studies of long-term kidney donor outcomes (6-45 years) have not shown excess mortality or ESRD. The limitation of the collective evidence is that the increased risks associated with GFR <60 ml/min per 1.73 m(2) were demonstrated in much larger cohorts than those reported for kidney donor outcomes, but donor outcome studies have substantially longer follow-up. On the basis of current findings, kidney donors with low GFR and no other signs of kidney disease should not be classified as having CKD. This is definitely not the reward they deserve, and, more important, the implications of reduced GFR in donors are not associated with unfavorable outcomes.
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Affiliation(s)
- Arthur J Matas
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
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26
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World MJ. Military nephrology: magnitude of rates of deterioration in renal function. J ROY ARMY MED CORPS 2013; 159:98-101. [DOI: 10.1136/jramc-2013-000071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
OBJECTIVE Evidence of the prevalence of renal pathology in military populations is rare, probably as a result of a traditionally cautious military medical attitude that limits applicants with evidence of renal disease joining the Armed Forces and the continued service of military personnel who develop this later. The aim of this paper is to provide the first comprehensive review of renal diseases in a British military population. METHODS An archive of out-patient consultations, discharge summaries and renal biopsies between 1985 and 2011 was reviewed. Cases were classified according to diagnosis providing a frequency distribution over this 26-year period. Serum creatinine concentration and demographic data permitted retrospective calculation of estimated glomerular filtration rate (eGFR) at presentation and follow-up. Calculation of an annualised rate of deterioration of eGFR (ml/min/1.73 m2/y) was undertaken when there were at least four follow-up values. In those cases where there was a statistically significant negative correlation with time, the probability of deterioration of renal function according to diagnosis was calculated. Where numbers of patients with a given diagnosis were sufficient for statistical purposes, correlations were also attempted between initial eGFR and both initial mean arterial pressure (MAP) and initial proteinuria. RESULTS The most frequent condition was IgA nephropathy, present in 115/346 (33%) of cases. Follow-up data permitted analysis of change in eGFR in 50 of these and 11 (22%) deteriorated. In this condition, there were statistically significant negative correlations between initial eGFR and MAP (r = -0.35, p = 0.0008) and proteinuria (r = -0.4, p = 0.0006). Other conditions showing deterioration despite therapeutic interventions included adult polycystic kidney disease (15/2 2 = 68%) and membranous nephropathy (4/ 7 = 57%). Altogether, 8/13 (61%) conditions included cases where eGFR deteriorated and this was present in 40/161 (25%) individual cases. CONCLUSIONS Cases of renal disease are discovered de novo in serving military personnel and, despite interventions to maintain renal function, a significant proportion deteriorate supporting the traditionally restrictive policy concerning applicants with evidence of renal disease.
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Affiliation(s)
- M J World
- Department of Nephrology, 7th Floor Area 5, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB
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28
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Dozier KC, Yeung LY, Miranda MA, Miraflor EJ, Strumwasser AM, Victorino GP. Death or Dialysis? the Risk of Dialysis-Dependent Chronic Renal Failure after Trauma Nephrectomy. Am Surg 2013. [DOI: 10.1177/000313481307900137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although renal trauma is increasingly managed nonoperatively, severe renovascular injuries occasionally require nephrectomy. Long-term outcomes after trauma nephrectomy are unknown. We hypothesized that the risk of end-stage renal disease (ESRD) is minimal after trauma nephrectomy. We conducted a retrospective review of the following: 1) our university-based, urban trauma center database; 2) the National Trauma Data Bank (NTDB); 3) the National Inpatient Sample (NIS); and 4) the U.S. Renal Data System (USRDS). Data were compiled to estimate the risk of ESRD after trauma nephrectomy in the United States. Of the 232 patients who sustained traumatic renal injuries at our institution from 1998 to 2007, 36 (16%) underwent a nephrectomy an average of approximately four nephrectomies per year. The NTDB reported 1780 trauma nephrectomies from 2002 to 2006, an average of 356 per year. The 2005 NIS data estimated that in the United States, over 20,000 nephrectomies are performed annually for renal cell carcinoma. The USRDS annual incidence of ESRD requiring hemodialysis is over 90,000, of which 0.1 per cent (100 per year) of renal failure is the result of traumatic or surgical loss of a kidney. Considering the large number of nephrectomies performed for cancer, we estimated the risk of trauma nephrectomy causing renal failure that requires dialysis to be 0.5 per cent. National data regarding the etiology of renal failure among patients with ESRD reveal a very low incidence of trauma nephrectomy (0.5%) as a cause; therefore, nephrectomy for trauma can be performed with little concern for long-term dialysis dependence.
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Affiliation(s)
- Kristopher C. Dozier
- From the Department of Surgery, University of California, San Francisco–East Bay, Alameda County Medical Center, Oakland, California
| | - Louise Y. Yeung
- From the Department of Surgery, University of California, San Francisco–East Bay, Alameda County Medical Center, Oakland, California
| | - Marvin A. Miranda
- From the Department of Surgery, University of California, San Francisco–East Bay, Alameda County Medical Center, Oakland, California
| | - Emily J. Miraflor
- From the Department of Surgery, University of California, San Francisco–East Bay, Alameda County Medical Center, Oakland, California
| | - Aaron M. Strumwasser
- From the Department of Surgery, University of California, San Francisco–East Bay, Alameda County Medical Center, Oakland, California
| | - Gregory P. Victorino
- From the Department of Surgery, University of California, San Francisco–East Bay, Alameda County Medical Center, Oakland, California
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Mandelbrot DA, Pavlakis M. Living donor practices in the United States. Adv Chronic Kidney Dis 2012; 19:212-9. [PMID: 22732040 DOI: 10.1053/j.ackd.2012.04.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 04/21/2012] [Accepted: 04/23/2012] [Indexed: 01/10/2023]
Abstract
Living kidney donation is a common procedure in the United States. Substantial variation exists between transplant centers in their protocols and exclusion criteria for potential living donors. In the absence of clinical trial data to guide decisions about exclusion criteria, knowledge of current practices is an important first step in guiding the formulation of donor protocols and future studies. Certain trends in living donation practices have become apparent from surveys of transplant programs over the past few decades. Over the past 25 years, opposition to living unrelated donation in the United States has gone from strong to essentially nonexistent. With respect to donor age, programs have become less strict regarding upper age limits but stricter regarding younger donor candidates. Protocols regarding kidney function, blood pressure, and diabetes screening also continue to evolve. Although donor follow-up is mandated by the Organ Procurement and Transplantation Network for 2 years after donation, a majority of donors are lost to follow-up by 1 year. The most commonly cited barriers to donor follow-up include donor inconvenience, cost issues including reimbursement to care providers, and direct and indirect costs to donors. In this article, we review the current knowledge about living donor practices in the United States.
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Srinivas TR, Poggio ED. Do living kidney donors have CKD? Adv Chronic Kidney Dis 2012; 19:229-36. [PMID: 22732042 DOI: 10.1053/j.ackd.2012.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 12/18/2022]
Abstract
Living kidney donor transplantation is an increasingly used treatment for end-stage renal disease because it both confers excellent outcomes to transplant recipients, and is considered a safe procedure for prospective donors. The short- and long-term safety of prospective donors is paramount to the continued success of living donation. Although the initial experience with living kidney donors mostly included the healthiest donors, increasing need for organs and secular trends in the general population have subtly reshaped prevailing suitability criteria for donation. As the practice of living donation evolved over time, our understanding of kidney disease has also changed as we embraced the framework of the K-DOQI guidelines. It is not uncommon for donors to fit into some of the K-DOQI guidelines paradigms of risk and disease; however, whether there is a true biological consequence or whether it is a merely semantic conundrum remains unclear. Regardless, this is an important issue, and therefore future efforts should aim at addressing this matter.
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31
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Peco-Antić A, Paripović D, Kotur-Stevuljević J, Stefanović A, Sćekić G, Miloševski-Lomić G. Renal functional reserve in children with apparently normal congenital solitary functioning kidney. Clin Biochem 2012; 45:1173-7. [PMID: 22732526 DOI: 10.1016/j.clinbiochem.2012.06.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 06/07/2012] [Accepted: 06/14/2012] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of the study was to investigate renal functional reserve (RFR) and to assess its relationship with serum cystatin C and blood pressure in children with apparently normal congenital solitary functioning kidney (SFK). MATERIAL AND METHODS RFR was obtained from the difference of endogenous creatinine clearance (CrCs) before and after a meat-free oral protein load (OPL) in the patients who were pre-treated with cimetidine. Serum cystatin C and urinary protein excretion were determined before and after OPL. RESULTS Among 22 patients (13 boys), aged 9.5 ± 4.3 years, 72.7% had increased serum cystatin C, and 54.5% had decreased RFR. Following OPL, CrCs and urine creatinine increased, while serum creatinine and cystatin C remained unchanged. The multiple regression analysis demonstrated that cystatin C could predict more than 90% of RFR variability. CONCLUSION Half of the patients with apparently normal SFK had decreased RFR. Serum cystatin C is one of the best predictors of RFR.
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Wolters HH, Vowinkel T. Risks in life after living kidney donation. Nephrol Dial Transplant 2012; 27:3021-3. [PMID: 22619313 DOI: 10.1093/ndt/gfs150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Heiner H Wolters
- Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
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Creatinine-based estimations of kidney function are unreliable in obese kidney donors. J Transplant 2012; 2012:872894. [PMID: 22315657 PMCID: PMC3270458 DOI: 10.1155/2012/872894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/07/2011] [Indexed: 12/11/2022] Open
Abstract
Accurate assessment of kidney function by measurement of glomerular filtration rate (GFR) is essential to the risk assessment of prospective living kidney donors. We evaluated the performance of various estimating equations for creatinine clearance (Cockcroft-Gault), GFR (Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration), and 24-hour urine collections for creatinine clearance in obese potential kidney donors. We evaluated 164 potential kidney donors including 49 with a BMI of 30–35 and 32 with a BMI >35 that have completed a routine living donor evaluation with a measured GFR. All the estimating equations performed poorly in obese donors. While 24-hour urine collections performed better, only 15% had an adequate 24-hour urine collection. Since obese kidney donors may be at higher than average risk for kidney failure, accurate assessment of kidney function in these donors is crucial to ensure their long-term health postdonation.
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Kher A, Mandelbrot DA. The living kidney donor evaluation: focus on renal issues. Clin J Am Soc Nephrol 2012; 7:366-71. [PMID: 22223615 DOI: 10.2215/cjn.10561011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Living kidney donor evaluations and follow-up have previously been addressed mostly by transplant physicians and surgeons. However, this area is significantly informed by basic principles of renal physiology and is of increasing clinical interest to general nephrologists. The general nephrology community is increasingly involved in evaluating the suitability of potential donors and in following them after donation when questions are raised about low GFR, hypertension, and other renal concerns. This article focuses on some of the most central and common issues that arise in evaluating potential donors and attempts to provide guidance on the basis of our review of the living donor literature, extrapolations from the general nephrology literature, and our own clinical experience.
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Affiliation(s)
- Ajay Kher
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Zarzecki M, Adamczak M, Wystrychowski A, Gross ML, Ritz E, Wiecek A. Exposure of Pregnant Rats to Cigarette-Smoke Condensate Causes Glomerular Abnormalities in Offspring. ACTA ACUST UNITED AC 2012; 36:162-71. [DOI: 10.1159/000341489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2012] [Indexed: 01/10/2023]
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Levey AS, Danovitch G, Hou S. Living Donor Kidney Transplantation in the United States—Looking Back, Looking Forward. Am J Kidney Dis 2011; 58:343-8. [DOI: 10.1053/j.ajkd.2011.06.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 06/15/2011] [Indexed: 11/11/2022]
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Morgan BR, Ibrahim HN. Long-term outcomes of kidney donors. Arab J Urol 2011; 9:79-84. [PMID: 26579273 PMCID: PMC4150560 DOI: 10.1016/j.aju.2011.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 04/02/2011] [Accepted: 04/07/2011] [Indexed: 12/20/2022] Open
Abstract
As the demand for kidney transplantation, particularly from living donors, continues to rise, there is increasing and much needed interest in accurately quantifying the long-term risks of kidney donation. We review the outcomes of kidney donors in the domains of survival, perioperative mortality, risk of end-stage renal disease, quality of life, course of diabetes mellitus in donors, pregnancy after donation, obesity, and prevalence of other health conditions.
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Affiliation(s)
- Benjamin R Morgan
- Division of Renal Diseases and Hypertension, University of Minnesota, MN, USA
| | - Hassan N Ibrahim
- Division of Renal Diseases and Hypertension, University of Minnesota, MN, USA
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38
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Renal carcinogenesis after uninephrectomy. Transl Oncol 2011; 2:258-63. [PMID: 19956387 DOI: 10.1593/tlo.09142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 03/06/2009] [Accepted: 06/23/2009] [Indexed: 01/07/2023] Open
Abstract
Nephrectomized rats have widely been used to study chronic renal failure. Interestingly, renal cell carcinoma occurred in the remnant kidney after uninephrectomy (UNX). In this study, we probed insulin-like growth factor (IGF)-1 signaling pathway in UNX-induced renal cancer. Adult male Sprague-Dawley rats were randomized into two groups: UNX rats (n = 22) and sham-operated rats (n = 12). Rats were killed at 3, 7, and 10 months. After 7 months after nephrectomy, the UNX rats developed renal cell carcinoma with increased expression of proliferating cell nuclear antigen, and 68.2% (15/22) of the animals exhibited invasive carcinoma. Western blot demonstrated significant down-regulation of IGF binding protein 3 contrasting with the up-regulation of protein kinase Czeta and Akt/protein kinase B in the renal cancer tissues. These findings indicate a unique rat model of UNX-induced renal cancer associated with enhanced IGF-1 signaling pathway.
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Cuevas-Ramos D, Almeda-Valdés P, Arvizu M, Mata J, Morales-Buenrostro L, Gabilondo B, Vilatobá M, Correa-Rotter R, Gabilondo-Navarro F, Mehta R, Aguilar-Salinas C, Alberú J, Gómez-Pérez F. Association of the Metabolic Syndrome and Long-Term Renal Function in Kidney Donors. Transplant Proc 2011; 43:1601-6. [DOI: 10.1016/j.transproceed.2011.02.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 02/15/2011] [Indexed: 01/06/2023]
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Live donor kidney transplantation: attitudes of patients and health care professionals concerning the pre-surgical pathway and post-surgical follow-up. Int Urol Nephrol 2011; 44:157-65. [PMID: 21614509 DOI: 10.1007/s11255-011-9987-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Accepted: 04/29/2011] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We surveyed the following groups of individuals concerning their attitudes towards the pathway leading up to live donor kidney transplantation (LDKT) and post-operative follow-up: kidney transplant (deceased and live donor) recipients, live kidney donors and medical and nursing staff caring for end-stage renal disease and dialysis patients. MATERIALS AND METHODS Participants were recruited within a tertiary renal and transplant centre and invited to complete anonymized questionnaires, be involved in focus groups and undertake structured interviews. RESULTS A total of 464 participants completed the questionnaire (36% health care professionals and 64% patients). Most perceived donor risk as small or very small (62%), and 49% stated that a potential donor should be given up to 3 months to reconsider the decision to donate. Participants were almost equally divided as to whether consensus of the donor's family is necessary (46%) or not (44%) in LDKT. Seventy-one percentage of the participants suggested that patients have a greater appreciation of a LDKT if they have been on dialysis; 58% of participants thought that donor and recipient should recuperate beside each other after surgery; 45% thought that the post-operative follow-up for the donor should last up to a year; and 83% thought that donor follow-up should include medical status and quality of life. In the interviews, participants expressed several interesting views. CONCLUSIONS Participants believed that LDKT is safe for the donor, and the pathway to surgery and post-operative follow-up should be performed in a way that ensures lack of coercion and includes family support and an extensive post-operative follow-up.
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Dols LFC, Kok NFM, Roodnat JI, Tran TCK, Terkivatan T, Zuidema WC, Weimar W, Ijzermans JNM. Living kidney donors: impact of age on long-term safety. Am J Transplant 2011; 11:737-42. [PMID: 21446976 DOI: 10.1111/j.1600-6143.2011.03465.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The safety of older live kidney donors, especially the decline in glomerular filtration rate (GFR) after donation, has been debated. In this study we evaluated long-term renal outcome in older live kidney donors. From 1994 to 2006 follow-up data of 539 consecutive live kidney donations were prospectively collected, during yearly visits to the outpatient clinic. Donors were categorized into two groups, based on age: < 60 (n = 422) and ≥ 60 (n = 117). Elderly had lower GFR predonation (80 vs. 96 mL/min respectively, p < 0.001). During median follow-up of 5.5 years, maximum decline in eGFR was 38% ± 9% and the percentage maximum decline was not different in both groups. On long-term follow-up, significantly more elderly had an eGFR < 60 mL/min (131 (80%) vs. 94 (31%), p < 0.001). However, renal function was stable and no eGFR of less than 30 mL/min was seen. In multivariate analysis higher body mass index (HR 1.09, 95%CI 1.03-1.14) and more HLA mismatches (HR 1.17, 95%CI 1.03-1.34) were significantly correlated with worse graft survival. Donor age did not influence graft survival. After kidney donation decline in eGFR is similar in younger and older donors. As kidney function does not progressively decline, live kidney donation by elderly is considered safe.
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Affiliation(s)
- L F C Dols
- Department of Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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Alnimri M, Laftavi M, Kohli R, Said M, Feng L, Patel S, Pankewycz O. African-American Women and Older Patients Are at Risk for a Greater Decline in Renal Function Following Living Kidney Donation. Transplant Proc 2011; 43:512-5. [DOI: 10.1016/j.transproceed.2011.01.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Tan JC, Busque S, Ho B, Myers BD. Debate: PRO Position. Formal assessment of donor kidney function should be mandatory. Am J Nephrol 2011; 33:198-200; discussion 205. [PMID: 21335961 DOI: 10.1159/000323230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Jane C Tan
- Department of Medicine, Division of Nephrology, Stanford University, Calif., USA.
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Abstract
Background Offering living kidney donation raised the concern that donors are exposed to unknown risks. All Swiss transplant centres therefore decided to start a prospective cohort study of living kidney donors in Switzerland. This paper describes the rationale for and implementation of this cohort study. Methods/design All kidney donors in Switzerland are registered and examined before donation and biennially after donation starting in the first year after nephrectomy. Before each follow-up visit, the study centre sends a package to the kidney donor containing the health questionnaire, blood and urine tubes and a prepaid envelope for sending the samples to the central laboratory. The donor makes an appointment with their family physician, who examines the donor and reports findings such as pain and other complaints, blood pressure, creatinine, albumin, all major health events and the state of mental and social well-being to the study centre. The family doctor draws the blood sample and mails it with the urine sample in the prepaid envelope. All data are centrally managed. All abnormal findings in the follow-up of individual donors are regularly discussed with the principal investigator, and necessary clinical changes made and recorded in the database. The health insurance of the recipient covers all costs of the donor follow-up. The main outcomes are the occurrence of albuminuria, hypertension and renal insufficiency. The secondary outcomes are major somatic and social events such as death, cardiovascular disease, stroke and depression. Discussion This prospective cohort offers unique opportunities to assess the risks of living kidney donation and will allow us to examine the risks associated with the methods used for nephrectomy in Switzerland (various forms of open surgery and laparoscopic nephrectomy). The prospective collection of all clinically relevant data and the regular monitoring of donors will allow timely interventions at early stages before serious kidney and general health problems occur.
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Affiliation(s)
- Gilbert T Thiel
- Swiss Organ Living Donor Health Registry, Division of Transplant Immunology and Nephrology, University Hospital of Basel, Basel, Switzerland
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Gaston RS, Young CJ. Living donor nephrectomy: understanding long-term risk in minority populations. Am J Transplant 2010; 10:2574-6. [PMID: 21114640 DOI: 10.1111/j.1600-6143.2010.03324.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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46
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Nogueira JM, Weir MR, Jacobs S, Breault D, Klassen D, Evans DA, Bartlett ST, Cooper M. A Study of Renal Outcomes in Obese Living Kidney Donors. Transplantation 2010; 90:993-9. [DOI: 10.1097/tp.0b013e3181f6a058] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Lapasia JB, Kong SY, Busque S, Scandling JD, Chertow GM, Tan JC. Living donor evaluation and exclusion: the Stanford experience. Clin Transplant 2010; 25:697-704. [PMID: 21044160 DOI: 10.1111/j.1399-0012.2010.01336.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The proportion of prospective living donors disqualified for medical reasons is unknown. The objective of this study is to delineate and quantify specific reasons for exclusion of prospective living donors from kidney donation. METHODS All adult prospective kidney donors who contacted our transplant program between October 1, 2007 and April 1, 2009 were included in our analysis (n = 484). Data were collected by review of an electronic transplant database. RESULTS Of the 484 prospective donors, 39 (8%) successfully donated, 229 (47%) were excluded, 104 (22%) were actively undergoing evaluation, and 112 (23%) were withdrawn before evaluation was complete. Criteria for exclusion were medical (n = 150), psychosocial (n = 22), or histocompatibility (n = 57) reasons. Of the 150 prospective donors excluded for medical reasons, 79% were excluded because of obesity, hypertension, nephrolithiasis, and/or abnormal glucose tolerance. One hundred and forty-seven (61%) intended recipients had only one prospective living donor, of whom 63 (42%) were excluded. CONCLUSIONS A significant proportion of prospective living kidney donors were excluded for medical reasons such as obesity (body mass index >30), hypertension, nephrolithiasis, and abnormal glucose tolerance. Longer-term studies are needed to characterize the risks to medically complex kidney donors and the potential risks and benefits afforded to recipients.
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Affiliation(s)
- Jessica B Lapasia
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Combat urologic trauma in US military overseas contingency operations. ACTA ACUST UNITED AC 2010; 69 Suppl 1:S175-8. [PMID: 20622614 DOI: 10.1097/ta.0b013e3181e45cd1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This article reports on the occurrences and patterns of genitourinary (GU) trauma in the contemporary high-intensity conflict of the overseas contingency operations (OCOs). METHODS The Joint Theater Trauma Registry was queried for all US military members who received treatment for GU wounds and concomitant injuries sustained in OCOs for >75 months between October 2001 and January 2008. RESULTS Of the 16,323 trauma admissions annotated in the Joint Theater Trauma Registry, 819 (5%) had one or more GU injuries. Of the GU casualties, 90% were sustained in Iraq and 65% were because of explosions. The average casualty age was 26 years (range, 18-58 years) and 98.5% were men. There were 887 unique GU injuries distributed as follows: scrotum, 257 (29.0%); kidney, 203 (22.9%); bladder, 189 (21.3%); penis, 126 (14.2%); testicle, 81 (9.1%); ureter, 24 (2.7%); and urethra, 7 (0.8%). Of the 203 patients with kidney injuries, 22% went to the operating room with 31 patients having nephrectomies. There were 189 bladder injuries with 26 patients (14%) having concomitant pelvic fractures. CONCLUSIONS This is the largest report of GU injuries during any military conflict. The distribution and percentage of casualties with GU injuries in the OCO are similar to those of previous conflicts. Consideration should be given to personnel protective equipment for the areas associated with GU injuries and predeployment training directed at the care of these injuries.
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Mjoen G, Midtvedt K, Holme I, Øyen O, Fauchald P, Bergrem H, Holdaas H. One- and five-year follow-ups on blood pressure and renal function in kidney donors. Transpl Int 2010; 24:73-7. [DOI: 10.1111/j.1432-2277.2010.01148.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Ostreicher I, Almeida JR, Campean V, Rauh M, Plank C, Amann K, Dotsch J. Changes in 11 -hydroxysteroid dehydrogenase type 2 expression in a low-protein rat model of intrauterine growth restriction. Nephrol Dial Transplant 2010; 25:3195-203. [DOI: 10.1093/ndt/gfq354] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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