Current Management of Patients With Acquired Solitary Kidney

Ekamol Tantisattamo, Donald C Dafoe, Uttam G Reddy, Hirohito Ichii, Connie M Rhee, Elani Streja, Jaime Landman, Kamyar Kalantar-Zadeh, Ekamol Tantisattamo, Donald C Dafoe, Uttam G Reddy, Hirohito Ichii, Connie M Rhee, Elani Streja, Jaime Landman, Kamyar Kalantar-Zadeh

Abstract

Persons with acquired solitary kidney, including those who have had a unilateral nephrectomy for living kidney donation, renal malignancies, or trauma, have decreased renal mass that leads to increased intraglomerular pressure and glomerular hyperfiltration. These physiologic adaptations of solitary kidney may exacerbate other preexisting and genetic conditions that could create a predisposition to or worsen glomerular pathologies, leading to unfavorable renal outcomes. Hence, these persons may benefit from special care and lifestyle modifications, including nutritional interventions. There is a lack of consensus and evidence for proper surveillance and management after nephrectomy, and misconceptions in both directions of having a "normal" versus "abnormal" kidney status may cause confusion among patients and healthcare providers pertaining to long-term kidney health monitoring and management. We have reviewed available data on the impact of lifestyle modifications, particularly nutritional measures, and pharmacologic interventions, on short- and long-term outcomes after nephrectomy. We recommend avoidance of excessively high dietary protein intake (>1 g/kg per day) and high dietary sodium intake (>4 grams/d), adequate dietary fiber intake from plant-based foods, a target body mass index of <30 kg/m2 (in non-athletes and non-bodybuilders), and judicious management of risk factors of progressive chronic kidney disease (CKD), and future studies should help to better determine optimal care practices for these persons.

Keywords: chronic kidney disease; dietary management; living donor renal transplantation; nephrectomy; proteinuria; solitary kidney.

Figures

Figure 1
Figure 1
Pathophysiological changes after unilateral native nephrectomy. ERPF, effective renal plasma flow; FSGS, focal segmental glomerulosclerosis; GFR, glomerular filtration rate; IL-10, interleukin-10; Kf; glomerular ultrafiltration coefficient; mTOR, mammalian target of rapamycin; SNGFR, single-nephron glomerular filtration rate; TGF-β, transforming growth factor-beta; ΔP; transcapillary hydraulic pressure gradient.
Figure 2
Figure 2
Etiologies of solitary kidney across age groups and factors determining long-term renal function, including nephron mass at the initial onset of having a solitary kidney and concomitant underlying renal anomalies or comorbidities. Duration of having a solitary kidney, depending on age at the onset of solitary kidney, also leads to possible cumulative lifetime risk for developing progressive chronic kidney disease (CKD). AKI, acute kidney injury; FSGS, focal segmental glomerulosclerosis.
Figure 3
Figure 3
Mechanism of renal injury from high-protein diet, high salt intake, and dehydration. CKD, chronic kidney disease; GFR, glomerular filtration rate; TGF-β1, transforming growth factor-beta 1.

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