TY - JOUR

T1 - Functional adaptation after kidney tissue removal in patients is associated with increased plasma atrial natriuretic peptide concentration

AU - Azawi, Nessn

AU - Jensen, Mia

AU - Jensen, Boye L

AU - Goetze, Jens P

AU - Bistrup, Claus

AU - Lund, Lars

N1 - © The Author(s) 2021. Published by Oxford University Press on behalf of the ERA.

PY - 2022

Y1 - 2022

N2 - BACKGROUND: Following nephrectomy, the remaining kidney tissue adapts by an increase in GFR. In rats, hyperfiltration can be transferred by plasma. We examined whether natriuretic peptides (ANP, BNP) increase in plasma proportionally with kidney mass reduction and, if so, whether the increase relates to an increase in GFR.METHODS: Patients (n = 54) undergoing partial or total unilateral nephrectomy at two Danish centers were followed for one year in an observational study. Glomerular filtration rate was measured before, 3, and 12 months after surgery. Natriuretic propeptides (proANP and proBNP) and aldosterone were measured in plasma before and at 24 hours, five days, 21 days, three months, and 12 months. Cyclic GMP was determined in urine.RESULTS: There was no baseline difference in GFR between total- and partial nephrectomy (90.1 mL/min ±14.6 vs. 82.9±18, p = 0.16). Single-kidney GFR increased after 3 and 12 months (12.0 and 11.9 ml/min/1.73m2, +23.3%). There was no change in measured GFR 3 and 12 months after partial nephrectomy. ProANP and proBNP increased 3-fold 24h after surgery and returned to baseline after five days. The magnitude of acute proANP and proBNP increases did not relate to kidney mass removed. ProANP, not proBNP, increased 12 months after nephrectomy. Plasma aldosterone and urine cGMP did not change. Urine albumin/creatine ratio increased transiently after partial nephrectomy. Blood pressure was similar between groups.CONCLUSION: ANP and BNP increase acutely in plasma with no relation to degree of kidney tissue ablation. After 1year, only unilateral nephrectomy patients display increased plasma ANP which could support adaptation.

AB - BACKGROUND: Following nephrectomy, the remaining kidney tissue adapts by an increase in GFR. In rats, hyperfiltration can be transferred by plasma. We examined whether natriuretic peptides (ANP, BNP) increase in plasma proportionally with kidney mass reduction and, if so, whether the increase relates to an increase in GFR.METHODS: Patients (n = 54) undergoing partial or total unilateral nephrectomy at two Danish centers were followed for one year in an observational study. Glomerular filtration rate was measured before, 3, and 12 months after surgery. Natriuretic propeptides (proANP and proBNP) and aldosterone were measured in plasma before and at 24 hours, five days, 21 days, three months, and 12 months. Cyclic GMP was determined in urine.RESULTS: There was no baseline difference in GFR between total- and partial nephrectomy (90.1 mL/min ±14.6 vs. 82.9±18, p = 0.16). Single-kidney GFR increased after 3 and 12 months (12.0 and 11.9 ml/min/1.73m2, +23.3%). There was no change in measured GFR 3 and 12 months after partial nephrectomy. ProANP and proBNP increased 3-fold 24h after surgery and returned to baseline after five days. The magnitude of acute proANP and proBNP increases did not relate to kidney mass removed. ProANP, not proBNP, increased 12 months after nephrectomy. Plasma aldosterone and urine cGMP did not change. Urine albumin/creatine ratio increased transiently after partial nephrectomy. Blood pressure was similar between groups.CONCLUSION: ANP and BNP increase acutely in plasma with no relation to degree of kidney tissue ablation. After 1year, only unilateral nephrectomy patients display increased plasma ANP which could support adaptation.

U2 - 10.1093/ndt/gfab327

DO - 10.1093/ndt/gfab327

M3 - Journal article

C2 - 34792174

VL - 37

SP - 2138

EP - 2149

JO - Nephrology, Dialysis, Transplantation

JF - Nephrology, Dialysis, Transplantation

SN - 0931-0509

IS - 11

ER -