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Prospective Measurement of Urinary Microalbumin in Living Kidney Donor Nephrectomy: Toward Understanding the Renal Functional Recovery Period

 Young Eun Yoon  ;  Kwang Suk Lee  ;  Kyung Hwa Choi  ;  Kwang Hyun Kim  ;  Seung Choul Yang  ;  Woong Kyu Han 
 JOURNAL OF UROLOGY, Vol.192(4) : 1172-1177, 2014 
Journal Title
Issue Date
Adult ; Albuminuria/physiopathology ; Albuminuria/therapy* ; Biomarkers/urine* ; Creatine/urine ; Delayed Graft Function/diagnosis ; Delayed Graft Function/urine ; Female ; Follow-Up Studies ; Glomerular Filtration Rate/physiology* ; Humans ; Living Donors* ; Male ; Nephrectomy* ; Postoperative Period ; Preoperative Care/methods* ; Prognosis ; Prospective Studies ; ROC Curve ; Recovery of Function* ; Time Factors
albuminuria ; delayed graft function ; kidney transplantation ; living donors ; nephrectomy
PURPOSE: We determined the clinical implications of perioperative urinary microalbumin excretion in relation to renal function after living donor nephrectomy. MATERIALS AND METHODS: Between August 2010 and January 2013, 259 donors undergoing live donor nephrectomy were enrolled in the study. The donor urinary albumin-to-creatinine ratio was measured perioperatively, and changes in perioperative urinary albumin-to-creatinine ratio and the implications of preoperative microalbuminuria (urinary albumin-to-creatinine ratio 30 mg/gm or greater) were investigated. The relationships between perioperative urinary albumin-to-creatinine ratio and recovery of renal function and implantation biopsy histology were also analyzed. RESULTS: Mean ± SD preoperative urinary albumin-to-creatinine ratio was 7.1±12.7 mg/gm. The urinary albumin-to-creatinine ratio was increased after 1 day (24.7±18.9 mg/gm, p <0.001) and stabilized after 1 month (10.3±10.7 mg/gm, p <0.001). Preoperative microalbuminuria was not associated with perioperative estimated glomerular filtration rate during a followup period of 6 months but was associated with histological abnormalities. Donors with a higher urinary albumin-to-creatinine ratio before donation, even in the normal range, consistently had an increased postoperative urinary albumin-to-creatinine ratio. A ROC curve analysis showed that age, preoperative estimated glomerular filtration rate and 1-month postoperative urinary albumin-to-creatinine ratio were highly predictive of delayed recovery of renal function (AUC 0.884, p <0.001). The 1-month postoperative urinary albumin-to-creatinine ratio was associated with delayed recovery of renal function (OR 1.05 for each 0.1 mg/gm increase, p=0.021). CONCLUSIONS: Donors with higher preoperative urinary albumin-to-creatinine ratio levels require close observation because there is a greater possibility of microalbuminuria developing after donation even if the ratio is within the normal range. A higher urinary albumin-to-creatinine ratio was also associated with delayed recovery of renal function and histological abnormalities.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kwang Hyun(김광현)
Yang, Seung Choul(양승철)
Yoon, Young Eun(윤영은)
Lee, Kwang Suk(이광석) ORCID logo https://orcid.org/0000-0002-7961-8393
Choi, Kyung Hwa(최경화)
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
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