Correlation of whole kidney hypertrophy with glomerular over‐filtration in live, gender‐mismatched renal transplant allografts

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Renal graft survival depends upon multiple factors, including glomerular hyperfiltration, immune rejection, infection, and the toxicities of immunosuppressive agents. The deleterious effects of nephron under‐dosing due to the smaller allograft size relative to recipient body mass have long been studied in animal models as well as in humans.1 These studies have suggested that nephron reduction in allografts results in “adaptive” hyperfiltration and hypertrophy of the remaining glomeruli. Such persistent glomerular hyperfiltration often results in excess mechanical stress on the capillary tufts, leading to glomerulosclerosis.1 Clinical factors associated with filtration overload in recipients include obesity, diabetes, and hypertension, as well as graft size mismatch.
Determining whether donor graft capacity can meet recipient metabolic demand is important in predicting graft survival and donor outcomes. Earlier studies have used donor body surface area,4 donor body weight,5 renal graft weight7 and cross‐sectional renal area on ultrasound10 as surrogate markers of nephron mass.11 We previously reported that the mean volume of the pretransplant grafted kidney increased approximately 27% after transplantation, with graft growth being most prominent in grafts from female donors to male recipients.12 The increase in kidney volume likely reflects excess filtration, resulting from the concomitant enlargement of glomerular volume. To date, however, there has been little information on whether the overall enlargement in kidney mass is related to histologic glomerular hypertrophy after transplantation.
This study was designed to evaluate short‐term changes in kidney volume, corresponding glomerular size, and biochemical parameters in 31 recipients of living donor kidney transplants at the time of donation and one year later. Measurement of glomerular size of protocol biopsied specimens allowed evaluation of the relationship between histologically determined glomerular hypertrophy and overall kidney mass on three‐dimensional computed tomography (3D‐CT) volumetry.

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