Nephron Number, Single-Nephron Workload, and Podometrics as Predictors of Renal Function After Nephrectomy
5 affiliations
- 1Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
- 2Department of Pathology, Medical University of Vienna, Vienna, Austria.
- 3Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
- 4Center for Medical Data Science, Institute of Clinical Biometrics, Medical University of Vienna, Vienna, Austria.
- 5Department of Medicine, Service of Nephrology and Hypertension, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
Abstract
Introduction
Nephrectomy results in abrupt nephron loss and variability in postoperative estimated glomerular filtration rate (eGFR) trajectories that are incompletely explained by baseline clinical factors. Adaptive hyperfiltration has been hypothesized to increase single-nephron workload, with potential consequences for podocyte structure. However, nephron number, single-nephron filtration, and podocyte structural characteristics have rarely been examined jointly as determinants of functional adaptation after nephron loss. We therefore evaluated their association with eGFR compensation after uninephrectomy.Methods
We retrospectively assessed nephron number, single-nephron filtration, and podometrics in patients undergoing nephrectomy for renal tumors, using imaging and stereology on nonneoplastic tissue. Renal compensation (ΔeGFR) was calculated at 1 year postsurgery, and structural-functional parameters were compared across ΔeGFR tertiles using analysis of variance.Results
A total of 54 patients (mean age: 67 ± 13 years; 43% female) were stratified into ΔeGFR tertiles. Presurgical baseline eGFR was 84 ± 15 ml/min per 1.73 m² and was similar across tertiles. Patients with the poorest compensation (most negative ΔeGFR) exhibited lower nephron number (0.81 ± 0.20 × 10⁶ vs. 1.12 ± 0.39 and 1.20 ± 0.42 × 10⁶ in the greater and intermediate compensation groups; P = 0.005), glomerular hypertrophy (3.0 ± 0.7 × 10⁶ μm³ vs. 2.2 ± 0.5 and 2.5 ± 0.6 × 10⁶ μm³ in the greater and intermediate compensation groups; P = 0.004), and higher single-nephron filtration (54 ± 15 nl/min per 1.73 m² vs. 42 ± 13 and 39 ± 13 nl/min per 1.73 m² in the greater and intermediate compensation groups; P = 0.005) preoperatively. Podocyte-specific metrics were similar across tertiles.Conclusion
Together, these findings frame compensatory adaptation after nephrectomy as a function of nephron endowment, structural changes, and single-nephron workload, extending beyond conventional clinical risk profiles alone. By integrating parameters rarely examined together, this study provides a comprehensive view of post-nephrectomy functional adaptation.
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BibTeX
@article{paschen2026nephron,
title = {{Nephron Number, Single-Nephron Workload, and Podometrics as Predictors of Renal Function After Nephrectomy}},
author = {Christopher Paschen and Maximilian C Wakonig-Koeller and Juliane Hennenberg and Johannes Kläger and Maja Nackenhorst and Andre Oszwald and Michael Kammer and Menno Pruijm and Nicolas Kozakowski and Dietmar Tamandl and Heinz Regele and Rainer Oberbauer},
journal = {Kidney international reports},
year = {2026},
month = sep,
doi = {10.1016/j.ekir.2026.107099},
url = {https://europepmc.org/article/PMC/PMC13717024},
note = {CC BY},
}
RIS
TY - JOUR
TI - Nephron Number, Single-Nephron Workload, and Podometrics as Predictors of Renal Function After Nephrectomy
AU - Christopher Paschen
AU - Maximilian C Wakonig-Koeller
AU - Juliane Hennenberg
AU - Johannes Kläger
AU - Maja Nackenhorst
AU - Andre Oszwald
AU - Michael Kammer
AU - Menno Pruijm
AU - Nicolas Kozakowski
AU - Dietmar Tamandl
AU - Heinz Regele
AU - Rainer Oberbauer
PY - 2026
DA - 2026/09/23
JO - Kidney international reports
DO - 10.1016/j.ekir.2026.107099
UR - https://europepmc.org/article/PMC/PMC13717024
AB - Introduction Nephrectomy results in abrupt nephron loss and variability in postoperative estimated glomerular filtration rate (eGFR) trajectories that are incompletely explained by baseline clinical factors. Adaptive hyperfiltration has been hypothesized to increase single-nephron workload, with potential consequences for podocyte structure. However, nephron number, single-nephron filtration, and podocyte structural characteristics have rarely been examined jointly as determinants of functional adaptation after nephron loss. We therefore evaluated their association with eGFR compensation after uninephrectomy.Methods We retrospectively assessed nephron number, single-nephron filtration, and podometrics in patients undergoing nephrectomy for renal tumors, using imaging and stereology on nonneoplastic tissue. Renal compensation (ΔeGFR) was calculated at 1 year postsurgery, and structural-functional parameters were compared across ΔeGFR tertiles using analysis of variance.Results A total of 54 patients (mean age: 67 ± 13 years; 43% female) were stratified into ΔeGFR tertiles. Presurgical baseline eGFR was 84 ± 15 ml/min per 1.73 m² and was similar across tertiles. Patients with the poorest compensation (most negative ΔeGFR) exhibited lower nephron number (0.81 ± 0.20 × 10⁶ vs. 1.12 ± 0.39 and 1.20 ± 0.42 × 10⁶ in the greater and intermediate compensation groups; P = 0.005), glomerular hypertrophy (3.0 ± 0.7 × 10⁶ μm³ vs. 2.2 ± 0.5 and 2.5 ± 0.6 × 10⁶ μm³ in the greater and intermediate compensation groups; P = 0.004), and higher single-nephron filtration (54 ± 15 nl/min per 1.73 m² vs. 42 ± 13 and 39 ± 13 nl/min per 1.73 m² in the greater and intermediate compensation groups; P = 0.005) preoperatively. Podocyte-specific metrics were similar across tertiles.Conclusion Together, these findings frame compensatory adaptation after nephrectomy as a function of nephron endowment, structural changes, and single-nephron workload, extending beyond conventional clinical risk profiles alone. By integrating parameters rarely examined together, this study provides a comprehensive view of post-nephrectomy functional adaptation.
SN - 2468-0249
ER -