How Do Living Kidney Donors Develop End-Stage Renal Disease?
How Do Living Kidney Donors Develop End-Stage Renal Disease?
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DOI：
10.1111/j.1600-6143.2009.02795.x
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发表时间：
2009-11-01
影响因子：
8.8
通讯作者：
Teraoka, S.
中科院分区：
文献类型：
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作者：
Kido, R.;Shibagaki, Y.;Teraoka, S.
活体肾供者半肾切除术后发生终末期肾病（ESRD）的临床过程和危险因素几乎没有研究。我们回顾了医疗记录，并确定了8例发展为慢性肾脏疾病（CKD） 5期或ESRD的供体，随后调查了术后临床病程与肾功能变化之间的关系。为了进行病例对照研究，我们还选择了一个由24名肾功能稳定且年龄、性别和捐赠后随访时间相匹配的捐赠者组成的对照组。除一名献血者因交通事故发生ESRD外，所有献血者均未在捐献后立即出现进行性肾功能障碍。他们的肾功能在很长一段时间内保持稳定，但在出现新的合并症，特别是CKD的进展因素（蛋白尿或高血压）或加速因素（心血管[CV]事件或感染）的危险因素后，肾功能开始下降。与对照供者相比，病例供者术后持续性蛋白尿、急性CV事件、严重感染和CKD加速因素住院的发生率均显著高于对照供者。这些结果提示长期（超过10年）随访供体的重要性，并特别注意CKD的危险因素。
The clinical course and risk factors for developing end-stage renal disease (ESRD) after heminephrectomy in living kidney donors have scarcely been investigated. We reviewed medical records and identified eight case donors who developed chronic kidney disease (CKD) stage 5 or ESRD, and subsequently investigated the association between postoperative clinical courses and changes in renal function. To conduct a case-control study, we also selected a control group comprising 24 donors who had maintained stable renal function and were matched for age, sex and follow-up time since donation. Except for one donor who developed ESRD caused by a traffic accident, none of the donors developed progressive renal dysfunction immediately after donation. Their renal functions remained stable for a long period of time, but started to decline after developing new comorbidities, especially risk factors known as progression factors (proteinuria or hypertension) or accelerating factors (cardiovascular [CV] event or infection) of CKD. As compared with the control donors, incidence of postoperative persistent proteinuria, acute CV event, severe infection and hospitalization due to accelerating factors of CKD were significantly higher in the case donors. These results suggest the importance of long-term (more than 10 years) follow-up of donors with special attention on the risk factors of CKD.