PRE-DONATION, BSA-NORMALIZED CT RENAL VOLUMETRY: A NOVEL PREDICTOR OF EARLY REMNANT KIDNEY DYSFUNCTION IN LIVING DONORS

 

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PRE-DONATION, BSA-NORMALIZED CT RENAL VOLUMETRY: A NOVEL PREDICTOR OF EARLY REMNANT KIDNEY DYSFUNCTION IN LIVING DONORS

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Manish
Malik
Manish Malik navyaanshumanish@gmail.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India *
Vidhya Shree shreevidhya430@gmail.com Sir Ganga Ram Hospital Department of Radiology and Imaging New Delhi India -
Akhilesh Kumar Jaiswal akhileshjaiswal@hotmail.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
Kishan Singh Rawat kishanrawat@gmail.com Sir Ganga Ram Hospital Department of Radiology and Imaging New Delhi India -
Anurag Yadav anuragyadav@gmail.com Sir Ganga Ram Hospital Department of Radiology and Imaging New Delhi India -
Tarun Kumar tarun.sindwani2024@gmail.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
Rajdeb Saha rajdeb@live.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
Vaibhav Tiwari drvt87@gmail.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
Anurag Gupta dranuragg1@yahoo.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
Vinant Bhargava vinant.bhargava@gmail.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
Ashwani Gupta ashwani_gupta2002@yahoo.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
Anil Kumar Bhalla bhallaak@yahoo.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
DS Rana dsrana39@gmail.com Sir Ganga Ram Hospital Department of Nephrology New Delhi India -
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Safeguarding long-term renal health is paramount in living donor kidney transplantation (LDKT). While pre-donation renal function is a key metric, predicting the functional capacity of the remnant kidney remains a challenge. CT-based renal volumetry offers an anatomical surrogate for nephron mass, yet its utility in predicting post-donation renal dysfunction is not well-established.

We conducted a prospective, single-centre study of 115 living kidney donors in India. Pre-donation CT renal angiography was used to measure total and cortical renal volumes, which were subsequently normalized to body surface area (BSA). Renal function, assessed by 24-hour creatinine clearance (CrCl) and urinary albumin-to-creatinine ratio (UACR), was measured at baseline and 6 months post-donation. The primary endpoint was early remnant kidney dysfunction, defined as a 6-month post-donation CrCl <60 mL/min and/or the development of microalbuminuria (UACR ≥30 mg/g).

At 6 months post-donation, 21.7% of donors developed early renal dysfunction, primarily manifested as new-onset microalbuminuria; no donor had a CrCl <60 mL/min. A lower pre-donation BSA-normalized total kidney volume was significantly associated with the development of this endpoint (p < 0.05). In multivariate analysis, BSA-normalized volume was a superior predictor of dysfunction compared to standard demographic variables including age, gender, and BMI. Receiver operating characteristic (ROC) curve analysis confirmed the robust predictive value of volumetric parameters for post-donation renal impairment.

Pre-donation, BSA-normalized renal volume assessed by CT is a powerful, non-invasive predictor of early remnant kidney dysfunction in living kidney donors. Integrating volumetric analysis into standard donor evaluation protocols can improve risk stratification, potentially enhancing the long-term safety and selection of LDKT candidates.

Kewords