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Published on: October 11, 2014
How do living kidney donors develop end-stage renal disease?
R Kido1, Y Shibagaki, K Iwadoh
1Department of Nephrology and Endocrinology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Ryo.kido@mb5.seikyou.ne.jp
Summary
Living kidney donors rarely develop end-stage renal disease (ESRD) soon after heminephrectomy. Long-term decline in renal function is linked to new comorbidities like proteinuria or hypertension, necessitating careful donor monitoring.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Heminephrectomy in living kidney donors is common, but long-term risks for renal disease are understudied.
- Understanding post-donation clinical courses is crucial for donor well-being.
Purpose of the Study:
- Investigate clinical courses and risk factors for end-stage renal disease (ESRD) in living kidney donors after heminephrectomy.
- Identify factors contributing to chronic kidney disease (CKD) progression in this population.
Main Methods:
- Retrospective review of medical records for eight case donors who developed CKD stage 5 or ESRD.
- Case-control study matching 24 control donors with stable renal function.
- Analysis of postoperative clinical courses and renal function changes.
Main Results:
- No immediate progressive renal dysfunction post-donation; stable function initially.
- Renal function decline occurred later, associated with comorbidities like proteinuria, hypertension, cardiovascular events, or infections.
- Case donors showed significantly higher incidences of persistent proteinuria, acute cardiovascular events, severe infections, and hospitalizations due to CKD accelerators compared to controls.
Conclusions:
- Long-term follow-up (over 10 years) for kidney donors is essential.
- Vigilance for CKD progression factors (proteinuria, hypertension) and accelerating factors (CV events, infection) is critical for donor health post-heminephrectomy.
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