Donating a kidney is a very noble thought. We usually screen for hematuria in the donors. Aysmptomatic hematuria is 13% in general population. Are donors with asymptomatic hematuria safe to donate?
This question is a tough one with no specific answers. A recent study in AJT July 2010 tries to answer this question in a retrospective study. 8.3% of kidney donors in 8 years of their evaluation had persistent hematuria pre donation that increased to 15% after donation and when persistent was associated with hypertension, proteinuria and renal damage. The authors go ahead and conclude that donation of someone with persistent hematuria is not ideal. What is persistent? Months or Years? Its usually on repeated testing at this point. Can be more than 2-3 tests in a short period of time or long period of time.
An editorial in the same issue takes a look at this question of possible donation in such cases.
An approach is suggested( no evidence but just opinion)
1. Repeat testing , assess for proteinuria and a 24 hour CRCL to make sure there is no renal damage. any indication of the above two would halt the donation
2. Nephrology assessment independent of the transplant center as a donor advocate.
3. Role of kidney biopsy might be helpful to help discern an occult IgA Nephropathy or genetic diseases such as Alport's Disease. Family members who have hematuria who are donating should raise concerns of potential genetic causes that might be the same cause in the recipient.
Living donor Transplants from relatives in Alport families is an ambivalent option. Based on one study in NDT 2009, proteinuria should be an exclusion criterion. Even in these donors with isolated hematuria, families and their physicians should be aware of an increased risk of renal failure in donor and recipient. Careful donor evaluation with a potential need of kidney biopsy might help make the decision easier.
This is a tough question that is hard to answer with any hard data. If there is alternate donor with NO hematuria, that would be ideal.
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- ► 2011 (370)
- Virtual Grand Rounds in Nephrology- E nephrology
- ASN's review on the ESRD bundling
- TOPIC DISCUSSION: EFFECT OF PROTEINURIA on combina...
- Poem from Pediatric Nephrologist
- TOPIC DISCUSSION: ACE induce angioedema replaced b...
- Nephsap review: Chronic Kidney Disease : CKD patie...
- Nephsap review: Chronic Kidney Disease: Troponin T...
- Bundled Payment for ESRD
- 2010 North American Dialysis and Transplantation (...
- Hematuria and Donation?
- TOPIC DISCUSSION: Do Peritoneal Dialysis patients ...
- Renal Fellow Network: Deciphering the pathologists...
- TOPIC DISCUSSION: TIDAL PD
- TOPIC DISCUSSION: DEXA SCAN in TRANSPLANT PATIENTS...
- CLINICAL CASE 21, ANSWERS AND SUMMARY
- Plagiarism In Application Essays????
- Micro RNAs and Transplantation
- IN THE NEWS: Anabolic Steroids and FSGS
- CLINICAL CASE 20, ANSWERS AND SUMMARY
- Pediatrics Grand rounds continue
- CONSULT ROUNDS: Severe Pre eclampsia
- Milk and CKD
- Transplant/Immunology Quiz 3 answers
- Rituximab and Cyclophosphamide: A Tale of Two Trea...
- CONSULT ROUNDS: HUS/TTP During Pregnancy
- IN THE NEWS: FACTOR H REPLETION in Atypical HUS
- Leflunomide and liver failure
- TOPIC DISCUSSION: Gadolinium and NSF- How to image...
- Lupus Nephritis Post Transplant
- Why do Internal Medicine Residents Choose Nephrolo...
- TOPIC DISCUSSION: TTP/HUS
- CONSULT ROUND: Hypercalcemia and Lithium
- CONSULT ROUND: ATHEROEMBOLIC DISEASE
- CONSULT ROUNDS:Rare and Interesting Cause of Hyper...
- TOPIC DISCUSSION: URR and Kt/V
- Organ Trading Discussion
- Dietary Management of Hypertension
- Chronic Dialysis: Now or Later?
- Photopheresis therapy for renal allograft rejectio...
- IN THE NEWS --->google as a diagnostician
- Live Donor Nephrectomy with vaginal extraction
- CLINICAL CASE 19, ANSWER AND SUMMARY
- IN THE NEWS- HYPOMAGNESEMIA AND PPI?
- JOB MARKET for RENAL FELLOWS
- Nephron Power: NYSN Fellows Boot camp
- NYSN Fellows Boot camp
- TOPIC DISCUSSION: captopril and stones?
- Topic Discussion: D-Lactate vs D-lactic acid
- ▼ July (48)