Prospective measurement of urinary microalbumin in living kidney donor nephrecto

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Prospective measurement of urinary microalbumin in living kidney donor nephrectomy: towards understanding the renal functional recovery period.
J. Urol.
J Urol 2014 Apr 1. Epub 2014 Apr 1.
Young Eun Yoon, Kwang Suk Lee, Kyung Hwa Choi, Kwang Hyun Kim, Seung Choul Yang, Woong Kyu Han
   
This study was conducted to determine the clinical implications of perioperative urinary microalbumin excretion in relation to renal function after living donor nephrectomy.
Between August 2010 and January 2013, 259 donors undergoing live donor nephrectomy were enrolled. Donor urinary albumin-to-creatinine ratio (UACR)
was measured perioperatively, and changes in perioperative UACR and the implications of preoperative microalbuminuria (MA; UACR≥30 mg/g) were investigated. The relationships between perioperative UACR and recovery of renal function and implantation biopsy histology were also analyzed.
Mean preoperative UACR was 7.1±12.7 mg/g. UACR was elevated after 1 day (24.7±18.9 mg/g; p<0.001) and stabilized after 1 month (10.3±10.7 mg/g; p<0.001). Preoperative MA was not associated with perioperative estimated glomerular filtration rate during a follow-up period of 6 months, but was associated with histological abnormalities. Donors with higher levels of UACR before donation, even in the normal range, consistently showed elevated postoperative UACR. An ROC curve analysis showed that age, preoperative eGFR, and 1-month postoperative UACR were highly predictive of delayed recovery of renal function (AUC=0.884; p<0.001). One-month postoperative UACR was associated with delayed recovery of renal function (odds ratio: 1.05 for each 0.1 mg/g increase; p=0.021).
Donors with higher preoperative UACR levels require close observation because they have a greater possibility of developing MA after donation, even if it is within the normal range. Higher UACR levels were also associated with delayed recovery of renal function and histologic abnormalities.
Affiliation
Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea. Electronic address: hanwk@yuhs.ac.