Detection and Clinical Patterns of Nephron Hypertrophy and Nephrosclerosis Among Apparently Healthy Adults.
BACKGROUND
Even among ostensibly healthy adults, there is often mild pathology in the kidney. The detection of kidney microstructural variation and pathology by imaging and the clinical pattern associated with these structural findings is unclear.


STUDY DESIGN
Cross-sectional (clinical-pathologic correlation).


SETTING & PARTICIPANTS
Living kidney donors at Mayo Clinic (Minnesota and Arizona sites) and Cleveland Clinic 2000 to 2011.


PREDICTORS
Predonation kidney function, risk factors, and contrast computed tomographic scan of the kidneys. These scans were segmented for cortical volume and medullary volume, reviewed for parenchymal cysts, and scored for kidney surface roughness.


OUTCOMES
Nephrosclerosis (glomerulosclerosis, interstitial fibrosis/tubular atrophy, and arteriosclerosis) and nephron size (glomerular volume, mean profile tubular area, and cortical volume per glomerulus) determined from an implantation biopsy of the kidney cortex at donation.


RESULTS
Among 1,520 living kidney donors, nephrosclerosis associated with increased kidney surface roughness, cysts, and smaller cortical to medullary volume ratio. Larger nephron size (nephron hypertrophy) associated with larger cortical volume. Nephron hypertrophy and larger cortical volume associated with higher systolic blood pressure, glomerular filtration rate, and urine albumin excretion; larger body mass index; higher serum uric acid level; and family history of end-stage renal disease. Both nephron hypertrophy and nephrosclerosis associated with older age and mild hypertension. The net effect of both nephron hypertrophy and nephrosclerosis associating with cortical volume was that nephron hypertrophy diminished volume loss with age-related nephrosclerosis and fully negated volume loss with mild hypertension-related nephrosclerosis.


LIMITATIONS
Kidney donors are selected on health, restricting the spectrum of pathologic findings. Kidney biopsies in living donors are a small tissue sample leading to imprecise estimates of structural findings.


CONCLUSIONS
Among apparently healthy adults, the microstructural findings of nephron hypertrophy and nephrosclerosis differ in their associations with kidney function, macrostructure, and risk factors.
['Denic|Aleksandar|A|', 'Alexander|Mariam P|MP|', 'Kaushik|Vidhu|V|', 'Lerman|Lilach O|LO|', 'Lieske|John C|JC|', 'Stegall|Mark D|MD|', 'Larson|Joseph J|JJ|', 'Kremers|Walter K|WK|', 'Vrtiska|Terri J|TJ|', 'Chakkera|Harini A|HA|', 'Poggio|Emilio D|ED|', 'Rule|Andrew D|AD|']
D000328:Adult D003430:Cross-Sectional Studies D005260:Female D006801:Humans D006984:Hypertrophy D008297:Male D009399:Nephrons D009400:Nephrosclerosis
nephron hypertrophy Nephrosclerosis kidney microstructure living kidney donor kidney function arteriosclerosis biopsy aging hypertension chronic kidney disease (CKD) risk factor contrast computed tomographic (CT) scan high-resolution imaging kidney macrostructure kidney volume subclinical renal pathology