Article Text

  1. R. Rishi,
  2. A. Andone,
  3. Y. Yuan,
  4. D. Baumgarten,
  5. W. C. O'Neill
  1. Renal Division, Emory University, Atlanta, GA


Family history of end-stage renal disease (ESRD) is a strong risk factor for chronic kidney disease (CKD), but the underlying mechanism is unknown. Kidney mass may also be a risk factor. Increased kidney size is associated with albuminuria in diabetes and with poorer prognosis in polycystic kidney disease. We investigated whether renal parenchymal volume (RPV) in adults is a risk factor for CKD by comparing RPV in potential living related and unrelated kidney donors. RPV was measured by tracing the kidneys, excluding sinus fat, calyces, and vessels on sequential transverse images from CT scans of 106 related and 51 unrelated potential kidney donors. Unrelated donors were more likely to be female and Caucasian, but there was no difference in age, body surface area (BSA), and body mass index (BMI). In a multivariate analysis that accounted for age, gender, BSA, and race, relatedness correlated strongly with RPV (p = .0034). After correction for BSA and gender, RPV was 6.3% larger in related donors. The increase was 7.3% in first-degree relatives and 2.7% in second-degree relatives. The increase was apparent when the end-stage diagnosis in the recipient was glomerulonephritis (7.3%), hypertension (6.6%), and other/unknown (7.8%) but not diabetes (1%). Glomerular filtration rate (GFR) was measured as the plasma clearance of iohexol given as a contrast agent for CT scan. Five blood plasma samples were obtained at 30-minute intervals starting 2 hours after the CT scan in 39 subjects. The dose of iohexol was determined by weighing the bottle and syringe before and after injection and iohexol concentration was measured by high-performance liquid chromatography (HPLC). GFR was derived from a single-pool model with a Brochner-Mortensen correction. The increase in RPV was not associated with a higher GFR, suggesting that there is a decrease in renal functional density. Therefore, we conclude that a family history of ESRD is associated with an increase in renal parenchymal volume that correlates with the degree of genetic similarity and may be disease specific; nevertheless more studies are needed to confirm these preliminary data.

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