From the National Kidney Foundation’s blog:
Q: I am a living kidney donor. One year after donation, my eGFR, based on serum creatinine and a 99mTc-DTPA renogram, is averaging 42. 24-hour creatinine clearance averages 55. I have no protein spilling, no hypertension, no diabetes. Local transplant nephrologists tell me this is of concern and that I am in Stage III CKD. My transplant center nephrologist says not to worry and everything is as expected. The difference in the two centers concerns me. Your thoughts?
A: If you have normal two kidney function, this should result in an glomerular filtration rate (GFR) of between 90 and 120 milliliters per minute per 1.73 meters squared. If I remove one kidney, then the total GFR should be between 45 and 60 milliliters per minute per 1.73 meters squared. You have function tests that are very close to this. I would have to examine you myself, but would offer the above thoughts for you to consider. These numbers are in the range of Stage 3 chronic kidney disease (CKD) which is between 30 and 59 milliliters per minute per 1.73 meters squared.
Could this possibly have been any more of a non-answer?
The living kidney donor who posed this question is obviously concerned about their health. Odds are, if they contacted NKF, they also conducted a web search, and read more than a few articles about GFR, kidney function the like. The confusion for this LKD, I’m guessing, originates in the oft-repeated propaganda that “the remaining kidney will do the work of two” and “kidney donors are just as healthy as non-donors”, et cetera, et cetera.
But we’re not the same:
– We are missing 50% of our nephrons.
– We have no renal reserve.
– We are hypertrophied, which means we are more vulnerable to damage, disease, toxins, and age.
Are the results ‘as expected’? From the perspective of the transplant center – probably. But from the query above, I suspect they failed to pass that along to their trusting living donor prior to harvesting her/his precious kidney.
Should the LKD mentioned above be worried? Absolutely. And they should make whatever lifestyle changes necessary to preserve their nephrons and remaining renal function.
Then they should begin the process of accepting that being a living kidney donor means never being ‘normal’ again – regardless of what the media reports.