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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2010  |  Volume : 21  |  Issue : 2  |  Page : 246-250
Remnant kidney function and size in living unrelated kidney donors after nephrectomy


1 Department of Transplantation, Tabriz University of Medical Sciences,Tabriz, Iran
2 Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Medical Research, Tabriz University of Medical Sciences, Tabriz, Iran
4 Drug Applied Research Center, Tabriz University of Medical Sciences; Young Researchers Club, Tabriz Islamic Azad University, Tabriz, Iran

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Date of Web Publication9-Mar-2010
 

   Abstract 

There are few published reports examining the extended outcome of donors after nephrectomy. The aim of present prospective study was to evaluate the changes of glomerular fil­tration rate (GFR) and ultrasonographic kidney size in unrelated living kidney donors during post­nephrectomy period. Thirty nine unrelated living kidney donors were prospectively followed after nephrectomy. Length, anterioposterior (AP) diameter, and cortical thickness of the kidney were determined before, one week and three months after nephrectomy. GFR and serum creatinine (Cr) level were assessed simultaneously. The mean age of participants was 25.41 ± 2.67 years with the male to female ratio of 29 to 10. Although GFR decreased 1 week after nephrectomy (P= 0.001), considering the pre-nephrectomy GFR as a result of both kidneys' function and half of its value as a marker of the remnant kidney's function [(123.68 ± 17.99)/2], the calculated GFR for the remnant kidney increased about 63% after one week and 91%, after three months of nephrectomy (P= 0.003). Remnant kidney length, AP diameter, and cortical thickness were significantly in­creased during post-nephrectomy follow up (P< 0.001, P< 0.001, and P= 0.001, respectively). Results of present study showed that the GFR of remnant kidney was increased after nephrectomy, and serum Cr level was not changed, despite the mild increase at first post nephrectomy week. Also, remnant kidney size increased following nephrectomy in donors.

How to cite this article:
Bohlouli A, Tarzamni M, Zomorodi A, Abdollahifard S, Hashemi B, Nezami N. Remnant kidney function and size in living unrelated kidney donors after nephrectomy. Saudi J Kidney Dis Transpl 2010;21:246-50

How to cite this URL:
Bohlouli A, Tarzamni M, Zomorodi A, Abdollahifard S, Hashemi B, Nezami N. Remnant kidney function and size in living unrelated kidney donors after nephrectomy. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Nov 18];21:246-50. Available from: http://www.sjkdt.org/text.asp?2010/21/2/246/60061

   Introduction Top


Rising numbers of patients reaching End-Stage Renal Disease (ESRD) intensify the demand for expansion of the living-kidney-donor pool. [1],[2] Live donor kidney transplantation results in excellent patient and graft survival with advan­ces in immune-suppression and medical manage­ment. [1],[3] Post-operative outcome of the donors has been evaluated with many reports exami­ning the outcome after donor nephrectomy, mainly in related kidney donors. [2],[4],[5],[6],[7],[8] Follow-up studies of the live donors indicate that kidney donation is currently a safe procedure with low morbidity and mortality similar to general po­pulation. [4],[5] On the contrary, some studies have claimed that living renal donation has calcu­lable long-term risks and complications that may not be apparent in the short term. [6],[7],[8]

According to the fact that regular donor follow­up identifies at-risk populations and potentially modifiable factors, [7] precise pre-donation eva­luation and long-term follow-up of kidney do­nors is necessary for detection and prevention of further complications. [9] Ultrasound exami­nation of the kidney is relatively inexpensive and provides a way to assess renal location, contour, and size. [10],[11],[12],[13],[14] Living kidney donation remains the predominant source of organs in developing countries where cadaveric trans­plantation has yet to establish roots, because of the lack of infrastructure or implementation of legal criteria for brain death. [9] In addition, in Iran live donor kidney transplantation has be­come more common in the last few years in comparison with cadaver donor transplantation as if the number of live kidney donations is much farther than international average. In this study we aimed to evaluate the changes of glomerular filtration rate (GFR) and kidney size in unrelated living kidney donors before, one week and three months after nephrectomy.


   Subjects and Methods Top


In this prospective study, we evaluated and followed up 52 unrelated living kidney donors who donated between July 2006 and August 2008 in Tabriz Imam Reza Hospital. All parti­cipants gave informed consent. Furthermore, the whole work was supervised and approved by the ethics committee at Tabriz University of Medical Sciences (TUMS) which is in com­pliance with the Helsinki Declaration.

Selection for donation by nephrologist and urologist in base of kidney donation criteria, accepting to participate in study were inclusion criteria. Receiving any medication which may affects renal blood flow and function, surgical complications and loss of follow up were ex­clusion criteria. Among 105 donors, 52 of these subjects accepted to participate in study and signed consent form, but only 39 donors com­pleted their follow up. Two subjects because of surgical complications and 11 subjects were lost to follow up, were excluded from the study.

All the donors underwent ultrasound assess­ment before nephrectomy, and then one week and three months after nephrectomy. All the sonographies were performed by Hitachi model EUB 525 (Hitachi Medical Corp, Tokyo, Japan) using convex probes 3.5& 7.5 MHz by one sonologist (M.K.T.). Grey scale ultrasonographic indices including cortical thickness, length and anterioposterior (AP) diameter of the both kid­neys prior to nephrectomy, and the remnant kidney post operation were documented.

Besides the ultrasonographic indices, systolic and diastolic blood pressures (mmHg), glome­rular filtration rate (GFR; mL/min), and serum creatinine (Cr) were determined simultaneously. GFR was calculated by Cockroft-Gault formu­la. Serum Cr level were determined by Jaffe method (mg/dL). Blood pressure measured using manual sphygmomanometer (VAQUEZ-LAU­BRY, Germany).

Statistical analyses were performed by SPSS version 13.0 for windows software package (SPSS Ins., Chicago, USA). Results are pre­sented as mean values and standard deviation (SD). Statistical significance between times of evaluation was estimated using general linear model repeated measures and Bonferroni tests. The results were considered significant when the P value was less than 0.05.


   Results Top


In all 39 subjects were included in the study. The mean age of participants was 25.41 ± 2.67 years with the male to female ratio of 29 to 10. The Right and left side nephrectomy was car­ried out in 11 and 23 subjects, respectively.

A one way repeated measures ANOVA was conducted to compare remnant kidney length, AP diameter, corex thickness, GFR, and serum Cr before nephrectomy, 1 week and 3 months after nephrectomy.

Changes in remnant kidney length, AP dia­meter of the kidney, cortical thickness, GFR and serum creatinine showed a significant cha­nge by three months; Wilks' Lambda= 0.17, F (2, 28) = 66.82, P< 0.001, multivariate partial eta squared= 0.827.

Wilks' Lambda= 0.017, F (2, 7) = 200.14, P< 0.001, multivariate partial eta squared= 0.983,

Wilks' Lambda= 0.16, F (2, 27)= 67.64, P< 0.001, multivariate partial eta squared= 0.834,

Wilks' Lambda= 0.378, F (2, 12)= 9.85, P= 0.003, multivariate partial eta squared= 0.622

Wilks' Lambda= 0.50, F (2, 12)= 5.84, P= 0.017, multivariate partial eta squared= 0.493, respectively [Figure 1] and [Figure 2].

Comparison of systolic and diastolic blood pressures revealed no significant difference, [Table 1].


   Discussion Top


The aim of present study was to evaluate and compare the Doppler ultrasonographic findings of the remnant kidney in living unrelated kid­ney donors at one week and three months after nephrectomy. To the best of our knowledge, this is only studyof the remnant kidney size and GFR changes in living unrelated kidney donors.

Results of present study revealed that GFR of remnant kidney increased one week and three months after nephrectomy and serum Cr levels similarly decreased. This change was associa­ted at the same time in the increase in remnant kidney diameters.

Several studies have reported that surgical ab­lation of renal tissue such as uni-nephrectomy leads to an increase in GFR in the remaining kidney [15] from half the preoperative level to an average of 70-80% of the two-kidney perfor­mance by 2-4 weeks after nephrectomy [16] and around 85% after 2-6 years. [15] The functional compensation is obviously seen in an increase of the remaining functional volume of donor kidneys after nephrectomy. [17] In the present study, the calculated GFR for the remnant kid­ney increased about 63% after one week and 91%, three months after nephrectomy [Table 1]. In fact, the loss of one kidney from either disease or surgical remove results in compen­satory changes in the remaining kidney. [18] Pri­mary studies have reported similar results and shown that the creatinine clearance increases to 72-78% of the preoperative creatinine clea­rance within several weeks postoperatively and then stabilizes or increases very slightly for more than 10 years after nephrectomy. [19],[20]

In a recent study by Ibrahim et al. in more than 3000 kidney donors who donated kidney from 1963 till 2007, showed that overall mor­tality and ESRD was similar to the general po­pulation. [21] The presence of lower GFR and hypertension was related to higher body mass index and older age. The presence of albumi­nuria correlated to the longer duration of dona­tion. In general the donors had a healthy out­come in comparison to the general population. Examination of donors by 99mTc-MAG3 in Hamscho et al study showed a functional in­crease of remaining kidney of 20% in the mean TER-MAG3 levels compared to the values of healthy carriers of two kidneys. [22] Our study results show that increase in GFR was con­sistent with increased in kidney size due to compensatory process in kidney.

In case of serum creatinine level, although its levels increased one week and three months after nephrectomy, but such rising volumes all were in normal limitation. Previous studies also have reported that the serum creatinine level usually increases up to 20% above baseline, while remaining within the normal range. [23]

Although we assessed the changes of the kid­ney size and function following 1 week and 3 months after nephrectomy, this study suffered from some limitations such as small sample size and short follow up duration.

In conclusion, the remnant kidney's function increased up to 63 to 90% at one week and three months after nephrectomy that was seen as an equal increase in GFR post-nephrectomy.

 
   References Top

1.Textor SC, Taler SJ, Driscoll N, et al. Blood pre­ssure and renal function after kidney donation from hypertensive living donors. Transplantation 2004;78:276-82.  Back to cited text no. 1  [PUBMED]    
2.Goldfarb DA, Matin SF, Braun WE, et al. Renal outcome 25 years after donor nephrectomy. J Urol 2001;166:2043-7.  Back to cited text no. 2  [PUBMED]    
3.Lima DX, Petroianu A, Hauter HL. Quality of life and surgical complications of kidney donors in the late post-operative period in Brazil. Nephrol Dial Transplant 2006;21:3238-42.  Back to cited text no. 3  [PUBMED]    
4.Ota K. Current status of organ transplantations in Asian countries. Transplant Proc 2003;35:8­11.  Back to cited text no. 4  [PUBMED]    
5.Jordan J, Sann U, Janton A, et al. Living kid­ney donors' long-term psychological status and health behavior after nephrectomy: A retrospec­tive study. J Nephrol 2004;17:728-35.  Back to cited text no. 5  [PUBMED]    
6.Ellison MD, McBride MA, Taranto SE, Delmo­nico FL, Kauffman HM. Living kidney donors in need of kidney transplants: A report from the organ procurement and transplantation network. Transplantation 2002;74:1349-51.  Back to cited text no. 6      
7.Azar SA, Nakhjavani MR, Tarzamni MK, Faragi A, Bahloli A, Badroghli N. Is living kidney donation really safe? Transplant Proc 2007;39:822-3.  Back to cited text no. 7  [PUBMED]    
8.Gracida C, Espinoza R, Cancino J. Can a living kidney donor become a kidney reci­pient? Transplant Proc 2004;36:1630-1.  Back to cited text no. 8  [PUBMED]    
9.El-Agroudy AE, Sabry AA, Wafa EW, et al. Long-term follow-up of living kidney donors: a longitudinal study. BJU Int 2007;100:1351-5.  Back to cited text no. 9  [PUBMED]    
10.Galesic K, Brkljacic B, Sabljar-Matovinovic M, Morovic-Vergles J, Cvitkovic-Kuzmic A, Bo­zikov V. Renal vascular resistance in essential hypertension: Duplex-Doppler ultrasonographic evaluation. Angiology 2000;51:667-75.  Back to cited text no. 10      
11.Khosroshahi HT, Tarzamni MK, Gojazadeh M, Bahluli A. Color Doppler findings in trans­planted kidneys and remnant kidneys of donors 6 to 12 months after kidney transplantation. Transplant Proc 2007;39:816-8.  Back to cited text no. 11  [PUBMED]    
12.Avasthi PS, Voyles WF, Greene ER. Noninva­sive diagnosis of renal artery stenosis by echo­Doppler velocimetry. Kidney Int 1984;25:824­-9.  Back to cited text no. 12  [PUBMED]    
13.Krumme B, Blum U, Schwertfeger E, et al. Diagnosis of renovascular disease by intra­and extra renal Doppler scanning. Kidney Int 1996;50:1288-92.  Back to cited text no. 13  [PUBMED]    
14.Krumme B, Rump LC. Colour Doppler son­ography to screen for renal artery stenosis­technical points to consider. Nephrol DialTransplant 1996;11:2385-9.  Back to cited text no. 14      
15.Davison JM, Uldall PR, Walls J. Renal func­tion studies after nephrectomy in renal donors. Br Med J 1976;1:1050-2.  Back to cited text no. 15  [PUBMED]    
16.Pabico RC, Mc Kenna BA, Freemann BB. Re­nal function before and after unilateral neph­rectomy in renal donors. Kidney Int 1975;8: 165-75.  Back to cited text no. 16      
17.Even-Sapir E, Gutman M, Lerman H, et al. Kidney allografts and remaining contralateral kidneys before and after transplantation: as­sessment by quantitative 99mTc-DMSA SPECT. J Nucl Med 2002;43:584-8.  Back to cited text no. 17  [PUBMED]    
18.Wesson LG. Compensatory growth and other growth responses of the kidney. Nephron 1989;51:149-84.  Back to cited text no. 18  [PUBMED]    
19.Vincenti F, Amend WJ, Kaysen G, Feduska N, Birnbaum J, Duca R. Long-term renal function in kidney donors. Sustained compensatory hy­perfiltration with no adverse effects. Trans­plantation 1983;36:626-9.  Back to cited text no. 19      
20.Talseth T, Fauchald P, Skrede S, Djoseland O, Berg KJ, Stenstrem J. Long-term blood pre­ssure and renal function in kidney donors. Kidney Int 1986;29:1072-6.  Back to cited text no. 20      
21.Ibrahim HN, Foley R, Tan LP, et al. Long term consequences of kidney donation. N Engl J Med 2009;360:459-69.  Back to cited text no. 21      
22.Hamscho N, Wilhelm A, Dobert N, Menzel C, Gossmann J, Berner U. Residual kidney func­tion after donor nephrectomy. Assessment by 99mTc-MAG3-clearance. Nuklearmedizin 2005; 44:200-4.  Back to cited text no. 22      
23.Najarian JS, Chavers BM, McHugh LE, Matas AJ. 20 years or more of follow-up of living kidney donors. Lancet 1992;340:807-10.  Back to cited text no. 23  [PUBMED]    

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Correspondence Address:
Nariman Nezami
Clinical Pharmacy Laboratory Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz 5165665811
Iran
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