Risk of live kidney donation--Indian perspective.

INTRODUCTION: Live kidney donation is an established form of organ donation but carries the risk of an unnecessary surgery in a normal individual for the benefit of the recipient. Long term effects of nephrectomy have not been studied in Indian donors so far. AIM: The aim of this pilot study was to review the effects of kidney donation on morbidity (renal function, BP and proteinuria), psychosocial outcome and mortality. MATERIAL AND METHODS: Fifty donors who had nephrectomy 3 months to 20 years prior formed the material of this study. Medical history (donor age at nephrectomy, duration post-nephrectomy, family history), physical examination including anthropometry and systolic and diastolic blood pressure (SBP and DBP) measurement pre and post nephrectomy were recorded. Evaluation of renal function included pre and post-nephrectomy urinalysis, determination of microalbuminuria, serum creatinine, blood urea, 24 hr urinary protein and creatinine estimation and calculation of creatinine clearance. Renal length was measured by ultrasonography. Quality of life (QOL) was assessed by a standard questionnaire. Donors with co-morbidities not related to nephrectomy were excluded from the analysis. Data was statistically analyzed. RESULTS: Twenty two donors (44%) were males and 28 (56%) females. Parents constituted the majority 39 (78%); 10 were siblings (20%) and 1 was a spousal donor. The mean age at donation was 41.26 +/- 8.12 years (25-54.16 years). Since kidney donation a mean time interval of 63 months (3-264 months) had elapsed. There was a mean rise of 9.96 mm Hg in SBP and 7.18 mm Hg in DBP. Hypertension was noted in 23(46%). 20 donors (40%) developed microalbuminuria (MAU) post nephrectomy and 7 (14%) developed overt proteinuria (> 300 mg/day). Mean GFR pre and post nephrectomy was 102.74 +/- 6.91 ml/min and 74.54 +/- 14.64 ml/min with a mean reduction of 28.2 +/- 13.57 ml/min. There was no significant change in serum creatinine after donation (0.97 +/- 0.09 mg/dl vs 1.22 +/- 0.82 mg/dl). There was an increase in renal length of 1.14 +/- 0.73 cm. None of the donors regretted donation. CONCLUSION: This pilot study reaffirms the safety of live kidney donation. There was a fall in GFR with consequent increase in renal length postnephrectomy. The long-term implications of the minimal increase in proteinuria and rise in blood pressure need to be evaluated in larger cohort of donors over a longer period of time. This study underscores the need for initiating a donor registry to achieve this objective.

Sodium transporters in kidney role in health and disease.

Sodium is an important cation and has an important role in BP regulation and ECF balance. Kidney plays an important role in sodium balance. Almost 99% of filtered sodium is reabsorbed. The absorption occurs via sodium transporters located in the various segments of the nephron. Each of these transporters has unique features and is blocked by a specific diuretic. The activating and inactivating mutations of these transporters are associated with important clinical syndromes. The understanding of these transporters and their mutations is essential for proper diagnosis and management of syndromes associated with the defects of these transporters. Also the knowledge of sodium transporters helps in understanding the role of kidney in pathogenesis of hypertension and pharmacodynamics of diuretic action.