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Association of Kidney Function and Metabolic Risk Factors With Density of Glomeruli on Renal Biopsy Samples From Living Donors

      OBJECTIVE

      To test the hypothesis that kidney function and metabolic risk factors are associated with glomerular density on renal biopsy samples from healthy adults.

      PATIENTS AND METHODS

      This study compared glomerular density with predonation kidney function, blood pressure, and metabolic risk factors in living kidney donors at Mayo Clinic in Rochester, MN, from May 10, 1999, to February 4, 2009. During implantation of the kidney allograft, an 18-gauge core needle biopsy sample of the renal cortex was obtained, sectioned, and examined by pathologists. Glomerular density was determined by the number of glomeruli (normal and sclerotic) divided by area of cortex.

      RESULTS

      The study sample of 1046 kidney donors had a mean of 21 glomeruli (0.8 sclerotic glomeruli) and a glomerular density of 2.3 glomeruli per square millimeter. In a subset of 54 donors, glomerular density inversely correlated with the mean glomerular area (rs=−0.28). Independent predictors of decreased glomerular density were older age, increased glomerular filtration rate, family history of end-stage renal disease, increased serum uric acid, and increased body mass index. Increased urine albumin excretion, hypertension, decreased high-density lipoprotein cholesterol, and metabolic syndrome were also associated with decreased glomerular density after age-sex adjustment. These associations were not explained by the presence of glomerulosclerosis, tubular atrophy, interstitial fibrosis, or arteriosclerosis on the renal biopsy sample. In older donors, decreased glomerular density was attenuated by an increased prevalence of glomerulosclerosis and tubular atrophy.

      CONCLUSION

      Decreased glomerular density is associated with many different kidney function and metabolic risk factors among relatively healthy adults and may represent an early state of increased risk of parenchymal injury.
      BMI (body mass index), CKD (chronic kidney disease), ESRD (end-stage renal disease), GFR (glomerular filtration rate), HDL (high-density lipoprotein)
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      Linked Article

      • The Aging Kidney: More Pieces to the Puzzle
        Mayo Clinic ProceedingsVol. 86Issue 4
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          In 1973, Darmady et al1 published a now “classic” article entitled “The Parameters of the Ageing Kidney.” In this autopsy study, the authors evaluated kidney tissue samples from 105 individuals, from birth to 101 years, who had died suddenly and in whom known renal disease or hypertension was absent. The main findings included a gradual shrinking of nephron volume beginning after the third or fourth decade of life and preservation of the ratio of glomerular surface area to proximal tubule volume (ratio of about 3:1) throughout the life span.
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