Larger nephron size, low nephron number, and nephrosclerosis on biopsy as predictors of kidney function after donating a kidney

Naim Issa, Lisa E. Vaughan, Aleksandar Denic, Walter K. Kremers, Harini A. Chakkera, Walter D. Park, Arthur J. Matas, Sandra J. Taler, Mark D. Stegall, Joshua J. Augustine, Andrew D. Rule

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


It is unclear whether structural findings in the kidneys of living kidney donors predict postdonation kidney function. We studied living kidney donors who had a kidney biopsy during donation. Nephron size was measured by glomerular volume, cortex volume per glomerulus, and mean cross-sectional tubular area. Age-specific thresholds were defined for low nephron number (calculated from CT and biopsy measures) and nephrosclerosis (global glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis). These structural measures were assessed as predictors of postdonation measured GFR, 24-hour urine albumin, and hypertension. Analyses were adjusted for baseline age, gender, body mass index, systolic and diastolic blood pressure, hypertension, measured GFR, urine albumin, living related donor status, and time since donation. Of 2673 donors, 1334 returned for a follow-up visit at a median 4.4 months after donation, with measured GFR <60 mL/min/1.73 m2 in 34%, urine albumin >5 mg/24 h in 13%, and hypertension in 5.3%. Larger glomerular volume and interstitial fibrosis/tubular atrophy predicted follow-up measured GFR <60 mL/min/1.73 m2. Larger cortex volume per glomerulus and low nephron number predicted follow-up urine albumin >5 mg/24 h. Arteriosclerosis predicted hypertension. Microstructural findings predict GFR <60 mL/min/1.73 m2, modest increases in urine albumin, and hypertension shortly after kidney donation.

Original languageEnglish (US)
Pages (from-to)1989-1998
Number of pages10
JournalAmerican Journal of Transplantation
Issue number7
StatePublished - Jul 2019

Bibliographical note

Funding Information:
This study was supported with funding from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK090358). We thank MiloD?Denić for assistance

Publisher Copyright:
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons


  • clinical research/practice
  • donors and donation: donor follow-up
  • glomerular filtration rate (GFR)
  • hypertension/antihypertensives
  • kidney transplantation/nephrology
  • kidney transplantation: living donor


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