Korean J Transplant.  2020 Dec;34(Supple 1):S16. 10.4285/ATW2020.OR-1188.

The effect of hyperfiltration mechanism on kidney function in Living-Donor Kidney Transplantation in Cipto Mangunkusumo Hospital, Jakarta, Indonesia: study on renal arterial resistive index, urinary vascular endothelial growth factor, neutrophil gelatinaseassociated lipocalin, and heparan sulfate

• Marbun MB
• Susalit E
• Aulia D
• Pandelaki J
• Bardosono S
• Purwanto B

• KMID: 2509136
• DOI: http://doi.org/10.4285/ATW2020.OR-1188

Abstract

Background
While adequate donors’ kidney function after donation is desired, some may recover incompletely and develop chronic kidney diseases. Hyperfiltration is an adapting mechanism to overcome nephrectomy-related kidney function loss. This study aims to explain adaptive and maladaptive hyperfiltration mechanism during the first 30 days postnephrectomy.
Methods
Longitudinal observational study was conducted on 46 kidney donors in Cipto Mangunkusumo Hospital in April–December 2019. Estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) were examined serially. Subjects were divided into adaptive (eGFR >60 mL/min/1.73 ㎡ and/or ACR <30 mg/g on day 30) and maladaptive group (eGFR <60 mL/ min/1.73 ㎡ and/or ACR >30 mg/g on day 30). Kidney resistive index (RI), urinary vascular endothelial growth factor (VEGF), and heparan sulfate (HS) were examined prenephrectomy and on day-2, day-7, and day-30 postnephrectomy. Urinary neutrophil gelatinase-associated lipocalin (NGAL) level was measured before and 6-hour postnephrectomy. Donors’ characteristic variables were analyzed using chi-square or Fisher test and logistic regression. Difference of RI, VEGF, NGAL, and HS between two groups were analyzed using Mann-Whitney or independent t-test.
Results
Out of 46 subjects, 40 were included in the final analysis. Nineteen donors (47.5%) underwent maladaptive hyperfiltration. Prenephrectomy eGFR was significantly different with value of 111.17 (11.38) mL/min/1.73 m 2 and 92.94 (13.21) mL/ min/1.73 m 2 and cutoff of 104.60 mL/min/1.73 m 2 . Outcomes of donors aged >45 years and arterial stiffness >50th percentile were significantly different (P=0.03 and P=0.01). Hyperfiltration was evidenced by significant changes in RI, VEGF, NGAL, and HS after nephrectomy. Significant difference between arcuate artery RI on day-2 and day-30 was found only in adaptive group.
Conclusions
Hyperfiltration does not alter kidney function on day-30 postnephrectomy. Prenephrectomy eGFR, age >45 years, and arterial stiffness are associated with day-30 postnephrectomy kidney function. RI of arcuate artery changes more prominently and rapidly in adaptive group. Further study evaluating kidney function and interfering variables within longer period is necessary.