TY - JOUR
T1 - Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis among Apparently Healthy Adults
AU - Denic, Aleksandar
AU - Alexander, Mariam P.
AU - Kaushik, Vidhu
AU - Lerman, Lilach O.
AU - Lieske, John C.
AU - Stegall, Mark D.
AU - Larson, Joseph J.
AU - Kremers, Walter K.
AU - Vrtiska, Terri J.
AU - Chakkera, Harini A.
AU - Poggio, Emilio D.
AU - Rule, Andrew D.
N1 - Publisher Copyright:
© 2016 National Kidney Foundation, Inc.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background: Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear. Study Design: Cross-sectional (clinical-pathologic correlation). Setting & Participants: Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011. Predictors Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness. Outcomes: Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation. Results: Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis. Limitations: Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings. Conclusions: Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.
AB - Background: Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear. Study Design: Cross-sectional (clinical-pathologic correlation). Setting & Participants: Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011. Predictors Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness. Outcomes: Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation. Results: Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis. Limitations: Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings. Conclusions: Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.
KW - Nephrosclerosis
KW - aging
KW - arteriosclerosis
KW - biopsy
KW - chronic kidney disease (CKD) risk factor
KW - contrast computed tomographic (CT) scan
KW - high-resolution imaging
KW - hypertension
KW - kidney function
KW - kidney macrostructure
KW - kidney microstructure
KW - kidney volume
KW - living kidney donor
KW - nephron hypertrophy
KW - subclinical renal pathology
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U2 - 10.1053/j.ajkd.2015.12.029
DO - 10.1053/j.ajkd.2015.12.029
M3 - Article
C2 - 26857648
AN - SCOPUS:84975175121
SN - 0272-6386
VL - 68
SP - 58
EP - 67
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 1
ER -