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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