Original article
Renal function is similar in solitary kidneys from patients with and without diabetes
La función renal es similar en los riñones únicos de los pacientes con y sin diabetes
Cristina Gluhovschia,1,
, Gheorghe Gluhovschib,1, Florica Gadaleana,c,1, Silvia Velciova,c, Ligia Petricaa,c, Bogdan Timarc,d, Adriana Kaycsac,e,h, Romulus Timarc,f,h
Corresponding author
a Division of Nephrology, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania
b Division of Nephrology, Romanian Academy of Medical Sciences, Emergency County Clinical Hospital, Timisoara, Romania
c Emergency County Clinical Hospital, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania
d Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania
e Department of Biochemistry, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania
f Department of Diabetes and Nutritional Diseases, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania
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The median time (interquartile range) until onset of haemostasis using the technique prior to BH (pre-BH) was 15 (15–20) min, and after a month of the BH technique (post-BH) the median was 10 (10–15) min (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.005).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Laura Baena, José L. Merino, Blanca Bueno, Beatriz Martín, Verónica Sánchez, Luca Caserta, Beatriz Espejo, Patricia Domínguez, Alicia Gómez, Vicente Paraíso" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Laura" "apellidos" => "Baena" ] 1 => array:2 [ "nombre" => "José L." 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"tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "189" "paginaFinal" => "194" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aumento de renalasa sérica en pacientes de diálisis peritoneal: ¿está relacionado con el riesgo de enfermedad cardiovascular?" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1080 "Ancho" => 1517 "Tamanyo" => 55318 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of serum renalase levels between patients and healthy subjects. 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class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "fn0010" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Division of Nephrology, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Division of Nephrology, Romanian Academy of Medical Sciences, Emergency County Clinical Hospital, Timisoara, Romania" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Emergency County Clinical Hospital, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Biochemistry, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Department of Diabetes and Nutritional Diseases, University of Medicine and Pharmacy “V.Babes”, Timisoara, Romania" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La función renal es similar en los riñones únicos de los pacientes con y sin diabetes" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Diabetes mellitus (DM) is associated during its evolution with renal function impairment. The progression of diabetic nephropathy is related to the processes of hypertrophy and hyperfiltration at the level of the kidneys. Early Glomerular Filtration Rate elevation plays a central role in the pathogenesis and progression of renal disease in diabetes.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The solitary kidney (SK) is also associated with hypertrophy and hyperfiltration phenomena. The question is raised whether the phenomena of hypertrophy and hyperfiltration in the SK associated with DM are summed up. SK status and DM could have an additive effect on hypertrophy and hyperfiltration.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The possibility exists of a greater risk of individuals with a SK to present nephropathy in the case of coexistence of associated diabetes mellitus.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">DM can be considered to represent a risk factor in case of association with the SK.</p><p id="par0025" class="elsevierStylePara elsevierViewall">However, it is worth remembering that only some of the diabetic patients develop diabetic nephropathy, which indicates the intervention of a genetic factor.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Due to the shortage of living kidney donors and the current DM pandemics, studying the association of the SK with DM is of paramount importance.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Many diabetic donor kidneys have been given to diabetic recipients with early graft survival being similar to that among nondiabetic recipients.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Becker et al. suggest that diabetic kidneys can safely expand the donor pool and that diabetic kidneys can be used in transplantation without risk to patient or graft survival. Preexisting diabetic injury in the donor may increase the risk for proteinuria, compromised renal function, and posttransplant glucose intolerance.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The aim of our study was to assess the significance of the association between the SK and the presence or absence of DM.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><p id="par0050" class="elsevierStylePara elsevierViewall">Eighty-four patients with SK and DM (group A), mean age: 62.46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.72 years, 36<span class="elsevierStyleHsp" style=""></span>M and 48<span class="elsevierStyleHsp" style=""></span>F, with a mean duration of a SK of 15.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>15.15 years were enrolled into the study. Six patients (7.14%) had a congenital SK.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The control group (group B) comprised 84 SK patients without DM of similar age and duration of existence of a SK: mean age: 61.58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.22 years, 23<span class="elsevierStyleHsp" style=""></span>M and 61<span class="elsevierStyleHsp" style=""></span>F, and mean duration of existence of a SK: 15.26<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>13.76 years. Four patients (4.76%) had a congenital SK.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The inclusion criteria were history of unilateral nephrectomy in patients with surgically acquired SK and presence of a SK confirmed by at least two imaging methods in patients with congenital SK.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee of the Emergency Clinical County Hospital Timisoara, Romania.</p><p id="par0070" class="elsevierStylePara elsevierViewall">All patients were assessed for serum Creatinine, GFR(CKD-EPI), glycemia, cholesterol, triglycerides, serum uric acid, proteinuria/24<span class="elsevierStyleHsp" style=""></span>h, systolic blood pressure (SBP), diastolic blood pressure (DBP), BMI. Patients from group A were also assessed for HbA1c.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Statistical analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Data is presented as mean value<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviation. Mean values were compared using the <span class="elsevierStyleItalic">t</span>-student test (parametric variables) or the Mann–Whitney <span class="elsevierStyleItalic">U</span>-test (non-parametric variables). Percentages were compared using the chi-square test.</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">The comparative assessment of SK patients with DM (group A) vs. SK patients without DM (group B) is presented in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">DM refers to patients with Type 2 DM.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The group of patients with SK and DM (group A) had a significantly higher BMI (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0007), significantly higher metabolic abnormalities: glycemia (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), triglycerides (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0004), uric acid (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.019), and significantly higher proteinuria/24<span class="elsevierStyleHsp" style=""></span>h (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006).</p><p id="par0095" class="elsevierStylePara elsevierViewall">The study group also had a higher prevalence of arterial hypertension (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003) and coronary artery disease (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.031).</p><p id="par0100" class="elsevierStylePara elsevierViewall">The group of patients with SK without DM (group B) presented higher DBP than the study group A (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001).</p><p id="par0105" class="elsevierStylePara elsevierViewall">There was no difference in the Glomerular Filtration Rate (GFR) between the two groups (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.962).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">A reduced renal mass such as occurs in SK patients may augment the renal glomerular hyperfiltration associated with diabetes mellitus and increase the risk of later developing nephropathy.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Experimentally, glomerular hyperfiltration has been shown to result from elevations in the glomerular capillary blood flow and the glomerular capillary hydraulic pressure.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">Experimental studies conducted by Whiteside et al. in dogs with DM induced by pancreatectomy found that after nephrectomy an additive effect on kidney hypertrophy was identified.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> Likewise, experimental studies in rats with streptozocin-induced DM showed that nephrectomy of a kidney is associated after 3 months with worsening of diabetes-induced glomerular injury.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Our study assessed 84 SK patients with DM as compared to 84 SK patients without DM.</p><p id="par0130" class="elsevierStylePara elsevierViewall">One objective of the study was to evaluate whether the adaptive phenomena of hypertrophy and hyperfiltration which accompany the SK are summed up with the ones encountered in DM, where the kidney also suffers phenomena of hypertrophy and hyperfiltration.</p><p id="par0135" class="elsevierStylePara elsevierViewall">There was no difference in the Glomerular Filtration Rate (GFR) between the two groups, as such the supposition of the summation of the phenomena of hypertrophy and hyperfiltration of the solitary kidney and of diabetes mellitus could not be proven.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In order to interprete these data we took into consideration the duration of SK existence in the two groups of patients. We observed a similar duration of SK existence. As such, if the adaptive phenomena of hypertrophy and hyperfiltration of the SK are amplified by the presence of DM, the patients with DM should have shown greater values of the GFR, which proved not to be the case in our study.</p><p id="par0145" class="elsevierStylePara elsevierViewall">It should be noted that in persons in whom nephrectomy was performed for a unilateral disease, the GFR will go up in time, reaching 75% of the normal value.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The congenital SK, due to its particular intrauterine development, presents about 75% of the nephrons of a person with 2 functional kidneys.</p><p id="par0155" class="elsevierStylePara elsevierViewall">The reduced number of persons with congenital SK did not allow for a statistical interpretation of the GFR in patients with congenital SK in our study.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The duration of DM in our study group was 8.78<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.55 years, a time frame in which the phenomena of hypertrophy and hyperfiltration are manifest, however these are not reflected in an increase of the GFR in our study.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Our study could argue in favor of the usage of living kidney donors with diabetes mellitus.</p><p id="par0170" class="elsevierStylePara elsevierViewall">We found however in the SK patients with DM significantly higher metabolic abnormalities: glycemia, triglycerides, uric acid, and significantly higher proteinuria/24<span class="elsevierStyleHsp" style=""></span>h. The study group also had a higher prevalence of arterial hypertension and coronary artery disease.</p><p id="par0175" class="elsevierStylePara elsevierViewall">It is known that patients with diabetes have an increased incidence of atherosclerotic cardiovascular, peripheral arterial, and cerebrovascular disease. Hypertension and abnormalities of lipoprotein metabolism are often found in people with diabetes.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">As the metabolic abnormalities and co-morbidities encountered in DM represent important risk factors and are amenable to therapeutic intervention, our study proves valuable in highlighting them.</p><p id="par0185" class="elsevierStylePara elsevierViewall">Proteinuria is a risk marker for renal disease progression.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> One cause for the increased proteinuria could be the phenomena of hypertrophy and hyperfiltration at the level of the kidneys. The significantly higher proteinuria (more than double) found in the SK patients with DM suggests that these patients present a higher degree of renal injury than those without DM, although this is not reflected in the GFR.</p><p id="par0190" class="elsevierStylePara elsevierViewall">The association of the SK with DM is thus important due to the presence of significantly higher metabolic abnormalities, of renal injury as reflected by the increased proteinuria and the increased frequency of arterial hypertension and coronary artery disease, which represent important risk factors and should be addressed therapeutically.</p><p id="par0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Given the role of the kidney in primary hypertension, as has been demonstrated by transplants from hypertensive animal donors to normotensive animal recipients, some centers deny hypertension which is also a pandemics in pre-existing donors whether living or cadaveric. As Becker has posited that diabetic kidneys can safely expand the donor pool, this has inspired the present paper</span>.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conclusions</span><p id="par0200" class="elsevierStylePara elsevierViewall">Our study showed a higher value of proteinuria due to the phenomena of hypertrophy and hyperfiltration in the study group, significantly higher metabolic abnormalities: glycemia, triglycerides, uric acid, as well as a higher prevalence of arterial hypertension and coronary artery disease.</p><p id="par0205" class="elsevierStylePara elsevierViewall">There was no difference in the Glomerular Filtration Rate (GFR) between the two groups, as such the supposition of the summation of the phenomena of hypertrophy and hyperfiltration of the solitary kidney and of diabetes mellitus could not be proven.</p><p id="par0210" class="elsevierStylePara elsevierViewall">Patients with SK and DM should be carefully monitored from a nephrological viewpoint for proteinuria, GFR and arterial hypertension and for cardiovascular diseases.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Authors contribution</span><p id="par0215" class="elsevierStylePara elsevierViewall">Cristina Gluhovschi designed the study and wrote the paper. Gheorghe Gluhovschi, Florica Gadalean, Silvia Velciov, Ligia Petrica were responsible for the acquisition of data. Adriana Kaycsa performed the required laboratory determinations, while Romulus Timar critically read the manuscript.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical approval</span><p id="par0220" class="elsevierStylePara elsevierViewall">Informed consent was obtained from all patients included in the study.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0235" class="elsevierStylePara elsevierViewall">This research received funding from an Internal Grant of “Victor Babes” University of Medicine and Pharmacy Timisoara, PIII-C1-PCFI-2014/2015. The supporting source had no involvement in study design, in collection, analysis, and interpretation of data, in the writing of the report, and in the decision to submit the manuscript for publication.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflict of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:16 [ 0 => array:3 [ "identificador" => "xres842789" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec837998" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec838000" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres842790" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objectivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec837999" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Authors contribution" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Ethical approval" ] 12 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 13 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 14 => array:2 [ "identificador" => "xack283126" "titulo" => "Acknowledgement" ] 15 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-15" "fechaAceptado" => "2016-09-26" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec837998" "palabras" => array:3 [ 0 => "Diabetes mellitus (DM)" 1 => "Solitary kidney (SK)" 2 => "Proteinuria" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec838000" "palabras" => array:3 [ 0 => "SK" 1 => "DM" 2 => "GFR" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec837999" "palabras" => array:3 [ 0 => "Diabetes Mellitus (DM)" 1 => "Riñón único (SK)" 2 => "Proteinuria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Due to the shortage of living kidney donors and the current diabetes mellitus (DM) pandemic, studying the association of solitary kidney (SK) with DM is of paramount importance. Our aim was to assess the significance of the association between SK and DM.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Eighty-four patients with SK and DM (group A), with a mean age of 62.46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12.72 years, of whom 36 were males and 48 were females, were enrolled in the study.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The control group (group B) comprised 84 SK patients without DM of similar age and duration of existence of a SK. Mean age: 61.58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8.22 years, 23 males and 61 females. Serum creatinine, GFR (CKD-EPI), glycaemia, cholesterol, triglycerides, uric acid, proteinuria/24<span class="elsevierStyleHsp" style=""></span>h, systolic blood pressure (SBP), diastolic blood pressure (DBP) and BMI were assessed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The group of patients with SK and DM (group A) had a higher BMI (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0007), higher metabolic abnormalities (higher glycaemia [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001], triglycerides [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0004], uric acid [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.019] and proteinuria/24<span class="elsevierStyleHsp" style=""></span>h [<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006]). The study group also had a higher prevalence of hypertension (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.003) and coronary artery disease (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.031).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We found a higher value of proteinuria in the study group, significant metabolic abnormalities, as well as a higher prevalence of hypertension and coronary artery disease. However, no differences with respect to GFR were found, which could have significant implications for transplantation.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Materials and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectivos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Dada la reducción del número de los donantes vivos de riñones y la pandemia de diabetes mellitus (DM), estudiar la asociación del riñón único (RU) con la DM es de la mayor importancia. Nuestro objetivo fue evaluar la significación de la asociación entre el RU y la DM.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Han sido estudiados 84 pacientes con RU y DM (grupo A), con edad media de 62,46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>12,72 años; eran 36 hombres y 48 mujeres.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El grupo control (grupo B) ha estado compuesto por 84 pacientes con RU sin DM, de la misma edad y del mismo periodo de tiempo que el grupo A; la edad media de estos pacientes fue de 61,58<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>8,22 años; eran 23 hombres y 61 mujeres.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hemos evaluado la creatinina sérica, el FG (CKD-EPI), la glucemia, el colesterol, los triglicéridos, el acido úrico, la proteinuria de 24 h, la tensión arterial sistólica (TAS), la tensión arterial diastólica (TAD) y el IMC.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El grupo de los pacientes con RU y DM (el grupo A) tuvo valores mayores del IMC (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0007), anomalías metabólicas más elevadas (la glucemia [p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,001], los triglicéridos [p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0004], el acido úrico [p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,019] y una proteinuria/24 h también más elevada [p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,006]).</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">El grupo de estudio tuvo también una prevalencia elevada de la TA (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,003) y de la enfermedad arterial coronaria (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,031).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Hemos encontrado un valor más elevado de la proteinuria en el grupo estudiado, anomalías metabólicas importantes y también prevalencia más alta de la TA y de la enfermedad arterial coronaria, pero ninguna diferencia entre los FG, lo que puede tener una implicación importante en el trasplante.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objectivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:2 [ 0 => array:3 [ "etiqueta" => "g" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These authors contributed equally to this work.</p>" "identificador" => "fn0005" ] 1 => array:3 [ "etiqueta" => "h" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">These authors jointly oversaw the manuscript.</p>" "identificador" => "fn0010" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean (DS).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group A (n=84) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group B<br>(n=84) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62.5 (12.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61.6 (8.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.594 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Gender \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42.9 [n=36] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.4 [n=23] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">57.1 [n=48] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72.6[n=61] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.043 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of SK (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.7 (15.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15.3 (13.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.931 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age at nephrectomy for patients with surgically acquired SK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.4 (13.9)<br>[n=78] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48.6 (13.0)<br>[n=80] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.425 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Duration of DM (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.78 (8.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI(kg/sqm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30.9 (6.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.6 (5.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Systolic BP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">134.5 (21.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">140.5 (22.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.078 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diastolic BP(mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77.0 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.6 (13.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum Creatinine (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.8 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.5 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.340 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glycemia (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">170.2 (87.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">97.75 (16.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum cholesterol (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">201.5 (59.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">215.94 (62.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.137 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Serum triglycerides (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">225.2 (179.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">152.3 (73.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Uric acid (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6.6 (2.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.9 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HbA1c (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8.7 (2.1)<br>[n=41] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">- \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Proteinuria/24h (g/24h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.6 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.3 (0.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">GFR(ml/min.1.73sqm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.6 (25.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">50.8 (20.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.962 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Arterial Hypertension(%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">86.9[n=73] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67.9[n=57] \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1423358.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparative assessment of solitary kidney patients with (group A) and without Diabetes Mellitus (Group b).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Glomerular hyperfiltration and renal disease progression in 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