Prediction of Renal Function in Living Kidney Donors and Recipients of Living Donor Kidneys Using Quantitative Histology

Abstract

Background. Living kidney donors (LKDs) are at increased risk of chronic kidney disease, whereas transplant recipients experience progressive reduction of graft function. We examined the predictive value of quantitative stereology on renal function in LKDs and recipients of living donor kidneys, based on perioperative biopsies from the donated kidney. Methods. Cortex volume of both donor kidneys was determined by contrast-enhanced computed tomography and single-kidney glomerular filtration rate (GFR) by 51chrome-EDTA clearance together with renography. Glomerular density was used to estimate total glomeruli number in addition to glomerular volume, glomerular sclerosis, kidney fibrosis, and arteriole dimensions. GFR measurements were repeated 1 y after transplantation in both LKDs and recipients. Associations between GFR at follow-up and cortex volume and histomorphometric parameters after adjustment of age, gender, body mass index, smoking status, 24-h blood pressure, and single-kidney GFR were examined. Results. We included 49 LKDs (age, 51 ± 12 y) and 51 recipients (age, 44 ± 13 y). At follow-up, GFR was 71 ± 16 mL/min in LKDs and 61 ± 18 mL/min in recipients with hyperfiltration being more prominent in LKDs (30.4%) as compared to recipients (16.4%; P < 0.05). One-year GFR in donors correlated to cortex volume (P < 0.001) but not to any histological parameters, whereas GFR in recipients correlated to the amount of interstitial fibrosis (P < 0.01) but not to other histological parameters or cortex volume. Conclusions. Kidney cortex volume, but not renal histology parameters, predicts 1-y renal outcome in LKDs. In contrast, the amount of interstitial fibrosis, but not cortex volume, predicts 1-y graft function in recipients.

The relationship of peritubular capillary density with glomerular volume and kidney function in living kidney donors

“…Total GFR is the result of single nephron GFR and number of nephrons [ 2 ], so it would be interesting for future studies to investigate whether PTC density is in fact related to single-nephron GFR, and whether this explains the lack of an association with total GFR in healthy kidneys. Our finding that IF/TA in the pre-donation biopsy is not related to measured GFR post-donation confirms results from Buus et al [ 30 ]. We observed that individuals with more than 5% IF/TA had an increased tubular area and (a trend towards) a larger glomerular volume.…”