A 15-year-old boy with chronic kidney disease is being evaluated for kidney transplantation. He has had chronic glomerulonephritis for the last 3 years. His current estimated glomerular filtration rate is 12 mL/min. He also has hypertension and mild intermittent asthma. His sister, who is 22 years old, is willing to donate her kidney. She has no medical problems. The initial testing shows an ABO antigen match and one human leukocyte antigen mismatch. The sister should be appropriately counseled about which of the following long-term risks of kidney donation?

Question

A 15-year-old boy with chronic kidney disease is being evaluated for kidney transplantation.  He has had chronic glomerulonephritis for the last 3 years.  His current estimated glomerular filtration rate is 12 mL/min.  He also has hypertension and mild intermittent asthma.  His sister, who is 22 years old, is willing to donate her kidney.  She has no medical problems.  The initial testing shows an ABO antigen match and one human leukocyte antigen mismatch.  The sister should be appropriately counseled about which of the following long-term risks of kidney donation?

Quizplus · Accepted Answer

Explanation: The complications of donor nephrectomy can be divided into immediate and long-term risks. In the immediate period, risks are primarily those typical of surgical procedures, such as deep venous thrombosis and hospital-acquired infections. The overall surgical mortality rate is very low at 3.1/10,000 donors. The long-term risks of donor nephrectomy are also quite low. Although there is an immediate decrease in net glomerular filtration rate following donor nephrectomy, compensatory hypertrophy in the remaining kidney largely replaces the lost renal function. As a result, there is no increased risk of end-stage renal disease in kidney donors (Choice C). Overall mortality in kidney donors is also similar to that of the general population (Choice A). Kidney donation is, however, associated with an increased risk of gestational complications in female donors of childbearing age. These complications include fetal loss, preeclampsia, gestational diabetes, and gestational hypertension. They have been seen at higher rates in women after donor nephrectomy compared to the same women with pregnancies that occurred prior to nephrectomy (although the overall rates are not significantly higher than in the general population). It is generally recommended that women complete their planned childbearing prior to kidney donation. However, this is not an absolute contraindication to donation, and it is possible for women who have not completed childbearing to proceed with the procedure if they are appropriately informed of the risks. (Choice B) Kidney donors do not have an increased risk of depression and actually appear to have a somewhat lower risk than the general population. Possible factors include increased sense of well-being associated with organ donation and extensive pre-donation psychological screening. (Choice E) There is no increased risk of renal cell carcinoma or other malignancy among patients who have had a donor nephrectomy. Educational objective: The immediate and long-term complications of donor nephrectomy are low. Patients have an increased risk of gestational complications after donor nephrectomy compared to pregnancies before the procedure. However, the rate is similar to that of the general population. The risk of end-stage renal disease and overall mortality following kidney donation are the same as in the general population. References: Long-term consequences of kidney donation. (http://www.ncbi.nlm.nih.gov/pubmed/19179315) Pregnancy and birth after kidney donation: the Norwegian experience. (http://www.ncbi.nlm.nih.gov/pubmed/18853953) Pregnancy outcomes after kidney donation. (http://www.ncbi.nlm.nih.gov/pubmed/19353771)

A 15-Year-Old Boy with Chronic Kidney Disease Is Being Evaluated