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Informed Consent Living Donor Research Living Donor Risks Living Kidney Donor

Kidneys and Vitamin D

Here’s a valuable piece of information you probably don’t know: Kidneys help synthesize Vitamin D.

Vitamin D is not only essential in regulating phosphorus and calcium, which builds strong bones, but it also bolsters the immune and neuromuscular system, and plays a major role in the life cycle of cells.

According to one study:

“Vitamin D deficiency is known to cause osteoporosis and muscle weakness, increasing the risk for fractures due to falls, especially in elderly. Moreover, hypovitaminosis D is associated with an increased risk of multiple malignancies, metabolic and cardiovascular diseases, and immune disorders such as autoimmune diseases and high infection rates”

 

Other researchers found “that those who were deficient in vitamin D were more than twice as likely to develop albuminuria (a type of protein in the urine) over a period of five years. Albuminuria is an early indication of kidney damage as healthy kidneys capture protein for use in the body.”

“The study’s lead researcher, Matthew Damasiewicz, MD, concludes that there is mounting evidence on the benefits of correcting vitamin D deficiency to prevent albuminuria. “It is also likely that patients with chronic conditions such as [chronic kidney disease] CKD may need higher vitamin D levels than the general healthy population.”

 

What does all of this have to do with living kidney donors? Well, according to a 2009 study, 57.5 living kidney donors showed a Vitamin D deficiency after an average of 5 years post-donation.

LKDs only have (approximately) half of the Vitamin D synthesizing ability we did before. And many, many living kidney donors end up with GFRs which fall into the chronic kidney disease Stage 2 or 3 range. Despite the public hooplah, we are not immune to the physiological changes that occur in anyone else who has reduced kidney function. Consequently, it behooves us to pay attention and prevent/treat accordingly.

Take care of yourself.

 

 

 

Categories
Living Donor Research Living Donor Risks Living Kidney Donor

Living Kidney Donors Experience Bone Changes

I can only see the abstract, and this is far from perfect, but at least it acknowledges that living kidney donors *do* see changes in bone density metabolism. That, in itself, is a shift from the whole “don’t worry, you can donate a kidney and continue on your merry way with  no worries”.

Unfortunately, only one study is discussed (probably because no one else has bothered to examine the issue) which says that after a median 6.6 years post-donation, LKDs aren’t at a higher risk for fractures than the “general population selected for good health” (whoever those folks are; impossible to know if it’s a good matched cohort).

Like so many other health issue related to renal function and kidney donation, file this under “something to be aware of, and have tested on a regular basis”.

 

Naylor KL, & Garg AX (2014). Bone health in living kidney donors. Current opinion in urology PMID: 25144146

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Living Donor Risks

Lose Nephrons, Risk Bones

Potential living kidney donors are generally woefully uneducated about the functions of the renal system. One of the lesser known functions of the kidneys is to regulate Vitamin D, which is important for calcium and bone strength. As this abstract states:

“Reports from preclinical models provide a mechanism for surgically induced nephron loss leading to vitamin D and calcium metabolism dysregulation, resulting in osteoporosis”

 

They also state:

” Emerging retrospective data also suggest that nephron preservation in setting of surgical treatment of renal malignancy may reduce risk of chronic kidney disease and sequelae, including osteoporosis and fractures. ”

In other words, whenever possible, we should only remove as little of a kidney as possible to maintain not only renal function but reduce the risk of bone loss and disease.

 

If you’ve got the time. look around at the transplant industry generated websites, articles and pamphlets. Do any of them mention calcium, Vitamin D, bone loss, osteoporosis or otherwise?

 

 

 

Derweesh, I. (2014). Bone health and chronic kidney disease Current Opinion in Urology DOI: 10.1097/MOU.0000000000000103