|Year : 2019 | Volume
| Issue : 2 | Page : 115-117
Comparison of differential function of both kidneys in a healthy renal donor
Manish Gupta, Bharat Khadav, HL Gupta, TC Sadasukhi
Department of Urology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
|Date of Submission||24-Nov-2018|
|Date of Acceptance||19-Apr-2019|
|Date of Web Publication||28-Jun-2019|
Dr. Bharat Khadav
Department of Urology, Mahatma Gandhi Medical College and Hospital, Sitapura, Jaipur - 302 019, Rajasthan
Source of Support: None, Conflict of Interest: None
Background: End Stage Renal Disease or Renal Failure demands a Renal transplant for fruitful propagation of life. People can donate one of their two kidneys, and the remaining kidney is able to perform the necessary functions. Living-kidney donation is the most common type of living-donor procedure. But it has still to be ascertained which of the two is a better functional kidney amongst the two in a general healthy population. Aim and Objective: Our study aims to answer the same here i.e to Identify the better functioning kidney amongst the two in a healthy Renal Donor on the basis of DTPA Scaning. Materials and Methods: Ours was a observational study in which data was collected from the 398 patients who underwent donor nephrectomy at our institute from January 2014 to December 2017. A comparison of their DTPA scans was made and the results were evaluated. Results: Out of the 398 patients 298 were female and 100 were male donors. 39% of the donors evaluated had a differential function difference in the range of 0-5 percent. In both, men and women, the differential function steadily decreased with progress in age and was found to be statistically significant in both right and left kidneys. Conclusion: The main aim of our study was to find out the better functioning kidney amongst the two. And with the help of statistical analysis we were able to adjudge the right kidney a better functioning one.
Keywords: DTPA scan, living kidney donor, renal transplant
|How to cite this article:|
Gupta M, Khadav B, Gupta H L, Sadasukhi T C. Comparison of differential function of both kidneys in a healthy renal donor. Indian J Transplant 2019;13:115-7
|How to cite this URL:|
Gupta M, Khadav B, Gupta H L, Sadasukhi T C. Comparison of differential function of both kidneys in a healthy renal donor. Indian J Transplant [serial online] 2019 [cited 2019 Jul 19];13:115-7. Available from: http://www.ijtonline.in/text.asp?2019/13/2/115/261853
| Introduction|| |
The first successful kidney transplant was performed between identical twins in 1954. Since then, there has been a substantial increase in living kidney transplants. Living donor kidney transplantation is the treatment of choice for advanced renal failure. The living kidney transplantation program in India has evolved in the past 45 years and is currently the second largest program in numbers after the USA.
Transplantation from deceased donation where neurological criteria are used for determination of death has been possible since 1995 after the Indian parliament passed the law related to transplantation. It is estimated that almost 220,000 people require kidney transplantation in India. Against this, currently, approximately 7500 kidney transplantations are performed at 250 kidney transplant centers in India. Of these, 90% come from living donors and 10% from deceased donors.
One factor underlying this increase in living donor transplantation is the belief that donors have minimal perioperative and long-term risks from nephrectomy.
This large pool of data being collected from these transplants helps us to broaden our knowledge regarding the human body and how it tinkers.
The increasing success and safety of transplantation (including for marginal recipients), the associated widening gap between transplant and dialysis outcomes, and the lengthening waiting lists for cadaveric kidneys have led to a greater demand for donors. In turn, this has led to a greater willingness to consider and accept donors with isolated medical abnormalities (e.g., hypertension, obesity, and lower glomerular filtration rate [GFR]) and older age.
This was a prospective study, where healthy renal donors undergoing donor nephrectomies were evaluated on the basis of diethylenetriaminepentacetate (DTPA) scans to evaluate for the better functional kidney among the two.
| Methodology|| |
We collected data from the 398 patients who underwent donor nephrectomy at our institute from January 2014 to December 2017. It was an observational study in which living kidney donors were evaluated for their renal function and preanesthetic fitness for the procedure. Potential candidates for donor nephrectomy underwent a standard preoperative evaluation by the transplant division. A thorough history of the patient was obtained, and all nephrological ailments; both past and present, were investigated for; patients with a previous history of pyelonephritis were excluded. The preoperative kidney evaluation included renal echography, renal nuclear scan (DTPA scan), computed tomography angiography, and creatinine clearance. The renal function of the donor kidney was expressed as (donor kidney/both kidneys).
Apart from the mandatory blood, urine and radiological evaluation of all patients were also subjected to various medical, surgical, and psychological assessments before being subjected to donor nephrectomy.
A full medical history was taken, and weight, height, and body mass index were checked. A psychologist opinion was sought to evaluate the potential psychological impact of the donation on the donor.
With ethical committee clearance, the progressive observational study was commenced, data were tabulated, and data analysis with IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp., Armonk, NY: USA) was done.
| Results|| |
On statistical evaluation of the data, the following results were deduced. Of the 398 patients, 298 were female and 100 were male donors [Table 1]. The age ranged from 18 to 68 years, with maximum number of donors being in the age group of 41–50 years. The lowest GFR at which donation was conducted was 80 ml/min. Thirty-nine percent of the donors evaluated had a differential function difference in the range of 0%–5%, but this had no statistical significance [Table 2]. The maximum number of Renal arteries in a kidney was found out to be 3, but it had no significance when compared for their bearing on the differential renal function. In both men and women, the differential function steadily decreased with progress in age and was found to be statistically significant in both the right and left kidneys [Table 3] and [Table 4]. [Table 5] and [Table 6] demonstrate the comparison of both the kidney GFRs with the sex of the donors.
|Table 1: Comparison of glomerular filtration rate between the right and left kidneys in the study group|
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|Table 2: Difference of the right and left kidney glomerular filtration rate-wise distributions of cases in the study group|
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|Table 3: Comparison of the right kidney glomerular filtration rate according to age in the study group|
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|Table 4: Comparison of the left kidney glomerular filtration rate according to age in study group|
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|Table 5: Comparison of the right kidney glomerular filtration rate according to sex in the study group|
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|Table 6: Comparison of the left kidney glomerular filtration rate according to sex in the study group|
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| Discussion|| |
The kidneys filter blood, remove waste products, make hormones, and produce urine. The two kidneys drain through the ureters into the bladder where the urine is stored. In persons with end-stage renal disease, renal dialysis and kidney transplantation are the treatment options. Donated kidneys can come from deceased donors or from living donors. The GFR is considered to be the most important assessment of kidney function.
Donor nephrectomy is unique among major surgical procedures because it exposes an otherwise healthy patient to the risks of major surgery entirely for the benefit of another person. As per the guidelines prescribed by the Organ Procurement and Transplantation Network (2014), when renal function is normal, but there is a significant difference in function between the two kidneys, the kidney with lower function should be used for transplantation, or in other words, the better functioning kidney was left with the donor. As per this diktat, the relative renal function evaluation prior to the donor nephrectomy was of utmost importance. Nuclear renal scan is currently the gold standard imaging study to determine differential renal function.
The fractional renal uptake of intravenously administered Tc-99m DTPA, within 2–3 min following radiotracer arrival in the kidneys, is proportional to the GFR. Thus, it is possible to determine total, as well as individual kidney, GFR by a radionuclide technique which needs only 6 min of patient time and requires neither blood nor urine samples.
As concurred in our study, we found that the gender breakdown of living donors has not changed drastically over time, with the majority being female throughout the years. This is in accordance with the studies conducted by Dobson in 2002, Øien et al. in 2005, and Peracha et al. in 2016.,,
This finding requires targeted counseling and research to understand whether the cause is medical or sociocultural obstacles.
Most importantly, we found that the right kidneys' GFR was higher in comparison to the left kidney. We have thoroughly delved through the literature, and to the best of our knowledge and search, we bring this finding for the first time after observing the differential renal function by DTPA scan in our healthy donor population comparing both the genders in all age groups. Such a similar finding is unique to our study, and more studies are needed to support our observation in different ethnic groups.
| Conclusion|| |
The main aim of our study was to find the better functioning kidney among the two. Moreover, with the help of statistical analysis, we were able to adjudge the right kidney as a better functioning one. However, due to lack of similar studies, our results could not be compared with others. Hence, a need for furthering this study and in-depth analysis of the reason for the same need to be undertaken.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]