Hypertension and proteinuria: Long-term sequelae of uninephrectomy in humans

Hakim, Raymond M.; Goldszer, Robert C.; Brenner, Barry M.

doi:10.1038/ki.1984.112

Cited by 310 publications

(114 citation statements)

References 24 publications

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“…This difference increased with time from donation, suggesting a progressive effect. Higher levels of proteinuria are seen in donors with hypertension, [38][39][40] and males are at greater risk than females. 41 More recently, Ibrahim et al 35 reported that in 255 donors selected randomly from 3698 nephrectomies performed at the University of Minnesota between 1963 and 2007, 11.5% had microalbuminuria, whereas 1.2% had macroalbuminuria at a mean of 12.2 years after donation.…”

Section: Proteinuriamentioning

confidence: 98%

Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors?

et al. 2011

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Chronic kidney disease (CKD) is now a recognized global public health problem. It is highly prevalent and strongly associated with hypertension and cardiovascular disease (CVD); far more patients with a glomerular filtration rate below 60 ml min À1 per 1.73 m 2 will die from cardiovascular causes than progress to end-stage renal disease. A better understanding of the complex mechanisms underlying the development of CVD among CKD patients is required if we are to begin devising therapy to prevent or reverse this process. Observational studies of CVD in CKD are difficult to interpret because renal impairment is almost always accompanied by confounding factors. These include the underlying disease process itself (for example, diabetes mellitus and systemic vasculitis) and the complications of CKD, such as hypertension, anaemia and inflammation. Kidney donors provide an ideal opportunity to study healthy subjects without manifest vascular disease who experience an acute change from having normal to modestly impaired renal function at the time of uninephrectomy. Prospectively examining the cardiovascular consequences of uninephrectomy using donors as a model of CKD may provide useful insight into the pathophysiology of CVD in CKD and, therefore, into how the CVD risk associated with renal impairment might eventually be reduced.

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Section: Proteinuriamentioning

confidence: 98%

Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors?

et al. 2011

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“…The (10,11,13,19,25). The sum of the results of these five studies can be interpreted as showing that there is likely an increase in hypertension and proteinuria in male donors and, not unexpected, a loss of renal function of at least 20% in both genders.…”

Section: Comparisons and Controlsmentioning

confidence: 99%

Medical Risks in Living Kidney Donors

Ommen¹,

Winston²,

Murphy³

2006

Clinical Journal of the American Society of Nephrology

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“…There is a minimal incidence of hypertension and proteinuria in women ~20 years after kidney donation, and this is lower than in male kidney donors. 50 Although the parity of the female subjects in this study was not reported, it is likely that many underwent 1 or more pregnancies. 50 In another study, all indices of renal function were normal 8 years after kidney donation and after an average of 2 pregnancies.…”

Section: Long-term Effects Of Pregnancy On the Kidney When Maternal Rmentioning

confidence: 95%

“…50 Although the parity of the female subjects in this study was not reported, it is likely that many underwent 1 or more pregnancies. 50 In another study, all indices of renal function were normal 8 years after kidney donation and after an average of 2 pregnancies. 51 Although after 17 years and an average of 2 pregnancies, Davison 33 reports a slight (~10%) decline in GFR in women who had donated kidneys.…”

Section: Long-term Effects Of Pregnancy On the Kidney When Maternal Rmentioning

confidence: 95%

Impact of Pregnancy on Underlying Renal Disease

Baylis

2003

Advances in Renal Replacement Therapy

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Normal pregnancy involves marked renal vasodilation and large increases in glomerular filtration rate (GFR). Studies in rats reveal that the gestational renal vasodilation is achieved by parallel reductions in tone in afferent and efferent arterioles so GFR rises without a change in glomerular blood pressure. There is some evidence from animal studies that increased renal generation of nitric oxide (NO) may be involved. Although chronic renal vasodilation has been implicated in causing progression of renal disease in nonpregnant states by glomerular hypertension, there are no longterm deleterious effects of pregnancies on the kidney when maternal renal function is normal because glomerular blood pressure remains normal. When maternal renal function is compromised before conception, there are no long-term adverse effects on renal function in most types of renal disease, providing that the GFR is well maintained before conception. When serum creatinine exceeds ~ 1.4 mg/dL, pregnancy may accelerate the renal disease increases and when serum creatinine >2 mg/dL, the chances are greater than 1 in 3 that pregnancy will hasten the progression of the renal disease. The available animal studies suggest that glomerular hypertension does not occur despite diverse injuries. Thus, the mechanisms of the adverse interaction between pregnancy and underlying renal disease remain unknown. Index WordsGlomerular filtration rate; renal vasodilation; animal models; primary glomerular disease; diabetes There are profound hemodynamic changes in normal pregnancy including increases in plasma volume, red blood cell volume, and hence blood volume. Both stroke volume and heart rate increase leading to ~40% elevations in cardiac output, despite which, blood pressure (BP) falls because of large reductions in total peripheral vascular resistance (TPVR). [1][2][3] In addition to peripheral vasodilation, a vascular refractoriness to a variety of administered vasoconstrictors including angiotensin II develops quite early. [2][3][4] Striking changes also occur in kidney function, with an early increase in glomerular filtration rate (GFR), which is first detectable within 3 to 4 weeks after conception (Fig 1). 5 GFR continues to rise to a maximum of 40% to 50% above nonpregnant values by the end of the first trimester, and this increase is maintained throughout most of the pregnancy, although a fall in GFR occurs in the few weeks before delivery. 6 An optimal increase in GFR is a good prognosticator for a successful pregnancy outcome. As shown in Figure 1, in a serial study of normal pregnant women, 2 women who failed to show the early rise in GFR subsequently underwent early spontaneous abortion. 5 The rat is an excellent animal model for study because it exhibits systemic and renal hemodynamic changes during normal pregnancy that are similar to humans and the total gestation period in rats is only 22 days (Fig 2) volume expansion (which can reach 100% above the nonpregnant rat value) followed by a fall in blood pressure (although this is...

show abstract

Hypertension and proteinuria: Long-term sequelae of uninephrectomy in humans

Cited by 310 publications

References 24 publications

Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors?

Understanding the effects of chronic kidney disease on cardiovascular risk: are there lessons to be learnt from healthy kidney donors?

Medical Risks in Living Kidney Donors

Impact of Pregnancy on Underlying Renal Disease

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