BASE-LINE GLOMERULAR SIZE AS A PREDICTOR OF FUNCTION IN HUMAN RENAL-TRANSPLANTATION

Background. Nonimmune mechanisms have been implicated in chronic renal allograft injury. In experimental studies, a strong correlation exist s between glomerular size and the degree of glomerular sclerosis that develops after subtotal nephrectomy. Therefore, we assessed the impact of glomerular maximal planar area (MPA) in baseline biopsy specimens of human renal allografts on later graft function. Methods. The MPA wa s measured, by point counting and by computer planimetry, in postperfu sion biopsy specimens from 96 allograft kidneys from nonhypertensive d onors that had functioned for at least 2 years. Clinical data were ana lyzed throughout a follow-up period averaging 7.46+/-2.46 years. Resul ts. Both methods produced equivalent estimates of MPA. MPA proved to b e a strong predictor of late renal allograft function, with a signific ant correlation (P=0.02 to P<0.01) between MPA at baseline and later s erum creatinine level and creatinine clearance, beginning at 6 months after transplantation and persisting through follow-up. Creatinine lev el at discharge and occurrence of rejection were also independent pred ictors, whereas donor age, gender and race, cold ischemia time, cadave ric versus living donor, delay in initial function, and HLA mismatch d id not predict clinical outcome. Conclusion. Larger glomeruli at basel ine, measured by a simple point-counting technique, provide an early p redictor of risk for late allograft dysfunction and may identify a sub population of patients in whom treatment to prevent/ameliorate glomeru lar enlargement and/or hypertension may be efficacious.