Glomerular volume and renal histology in obese and non-obese living kidney donors

The link between obesity and renal disease is unclear, and there is no consensus as to whether obese individuals are at increased risk for kidney disease after living kidney donation if they otherwise meet acceptance criteria. We retrospectively studied time-zero (implantation) biopsies in 49 obese (body mass index (BMI) ≥30kg/m2) and 41 non-obese (BMI<30kg/m2) renal donors that met acceptance criteria. We found that our obese donor population had higher systolic blood pressure (P<0.001 vs non-obese) and higher absolute iothalamate clearance (P=0.001 vs non-obese) before donation. The obese donors had larger glomerular planar surface area compared to non-obese controls (P=0.017), and this parameter correlated with patient weight and urinary microalbumin excretion. Detailed examination of the biopsies revealed that although most histologic findings were similar between groups, the obese donors had more tubular dilation (P=0.01), but less tubular vacuolization (P=0.02) than the non-obese controls. There was also a trend toward more arterial hyalinosis in the obese patients than controls (P=0.08). From these data, our studies detected subtle differences in donor organs obtained from obese compared to non-obese individuals. Further studies should be carried out to quantify the long-term impact of these findings

Renal denervation in the antihypertensive arsenal - knowns and known unknowns.

Even though it has been more than a decade since renal denervation (RDN) was first used to treat hypertension and an intense effort on researching this therapy has been made, it is still not clear how RDN fits into the antihypertensive arsenal. There is no question that RDN lowers blood pressure (BP), it does so to an extent at best corresponding to one antihypertensive drug. The procedure has an excellent safety record. However, it remains clinically impossible to predict whose BP responds to RDN and whose does not. Long-term efficacy data on BP reduction are still unconvincing despite the recent results in the SPYRAL HTN-ON MED trial; experimental studies indicate that reinnervation is occurring after RDN. Although BP is an acceptable surrogate endpoint, there is complete lack of outcome data with RDN. Clear indications for RDN are lacking although patients with resistant hypertension, those with documented increase in activity of the sympathetic system and perhaps those who desire to take fewest medication may be considered