Section: USMLE

4) A 28-year-old man decides to donate a kidney to his brother, who is in chronic renal failure, after HLA typing suggests that he would be a suitable donor. He is admitted to the hospital, and his right kidney is removed and transplanted into his brother. Which of the following indices would be expected to be decreased in the donor after full recovery from the operation?

1. Creatinine clearance
2. Renal excretion of creatinine
3. Creatinine production
4. Daily excretion of sodium
5. Plasma creatinine concentration

Because creatinine is freely filtered by the glomerulus, but not secreted or reabsorbed to a significant extent, the renal clearance of creatinine is approximately equal to the glomerular filtration rate (GFR). In fact, creatinine clearance is commonly used to assess renal function in the clinical setting. When a kidney is removed, the total glomerular filtration rate decreases because 50% of the nephrons have been removed, which causes the creatinine clearance to decrease. In turn, the plasma creatinine concentration increases until the rate of creatinine excretion by the kidneys is equal to the rate of creatinine production by the body. Recall that creatinine excretion = GFR x plasma creatinine concentration. Therefore, creatinine excretion is normal when GFR is decreased following removal of a kidney because the plasma concentration of creatinine is elevated.

Creatinine is a waste product of metabolism. Creatinine production is directly related to the muscle mass of an individual, but is independent of renal function.

The daily excretion of sodium is unaffected by the removal of a kidney. The amount of sodium excreted each day by the remaining kidney exactly matches the amount of sodium entering the body in the diet.