Kasiske BI, Ma JZ, Louts TA, Swan SK
Long-term effects of reduced renal mass in humans

Kidney Int (Sep) 48:814-819 1995

Reduction of renal mass in experimental animals leads to proteinuria, systemic and glomerular hypertension, glomerular sclerosis and progressive renal damage. Some, but not all, studies in human suggests that reduced renal mass may be associated with systemic hypertension and renal disease akin to findings in experimental animals.

In this meta-analysis of 48 studies of 3124 patients with reduced renal mass (2988 subjected to unilateral nephrectomy, 107 with unilateral agenesis, 29 wih greater than 50% reduction in renal mass) and 1703 controls, the following findings emerge:
Uninephrectomy decreased GFR by 17.1 ml/min but with time GFR tended to increase (1.4 ml/min/decade), in all likelihood, due to functional and structural adaptation in the remaining kidney;
Uninephrectomy performed because of organ donation or injury did not lead to proteinuria whereas patients with a solitary kidney exhibited low grade progressive proteinuria (76 mg/day/decade); uninephrectomy led to a small static increase in diastolic pressure (3.1 mmHg) and a small, progressive increase in systolic pressure (2.4 mmHg, which increased 1.1 Hg/decade) but was not severe enough to increase the prevalence of systemic hypertension in the patients surveyed.

The analysis suggests that there is little if any risk of systemic hypertension or renal disease when there is a solitary kidney; important to the potential kidney donor, while there is a risk of a slight increase in systemic blood pressure, the increment is unlikely to lead to the diagnosis of systemic hypertension or to difficulties in securing medical insurance. (Karl A. Nath)

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CRF by problem area : Progression