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Proteinuria in living kidney donors

While this letter to the editor is from an Iranian transplant surgeon, therefore his prime intent is to defend Iran’s legalized kidney market (which is indefensible, imo), he makes some interesting statements about proteinuria in living kidney donors:

It is of interest that Gordon and Gill [1] explained some causes of microalbuminuria in living donors after nephrectomy such as inadequate pretransplant evaluation and conditions related to the poverty of unrelated donors. However, most reported data suggest that proteinuria increased in the living kidney donor population, and the prevalence of microalbuminuria in living donors varied from 11.5% to 34% in different studies [3, 4]. In addition, a study showed that 56% of 152 donors developed mild proteinuria (>150?mg/day) [5]. One meta-analysis demonstrated that the average proteinuria was 154?mg/day and concluded that kidney donation results in small increases in urinary protein [6]. The suggested causes of proteinuria postnephrectomy were subclinical hyperfiltration damage of the glomeruli, hypertension and a lower glomerular filtration rate.

Finally, it is generally accepted that all kidney donors should be screened for microalbuminuria at 2- to 3-year intervals postkidney donation because albuminuria has been illustrated as an appropriate indicator of kidney damage in the context of nephrectomy.

Notice the “generally accepted” part – accepted by whom? OPTN policies don’t reflect this, and neither does the official position of the US transplant industry. If proteinuria (and albuminuria is a protein), which is indicative of renal damage, is GENERALLY ACCEPTED by the medical literature and therefore, medical community, why aren’t prospective living donors informed as a matter of course?

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