Sahay Manisha, Narayen G
Department of Nephrology, Osmania Medical College/Osmania General Hospital, Hyderabad.
J Assoc Physicians India. 2007 Apr;55:267-70.
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.
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.
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.
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.
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.
活体肾捐赠是一种既定的器官捐赠形式，但对于一个健康个体而言，为了受赠者的利益而进行手术存在不必要的风险。迄今为止，印度捐赠者肾切除术后的长期影响尚未得到研究。
本初步研究的目的是评估肾捐赠对发病率（肾功能、血压和蛋白尿）、心理社会结局及死亡率的影响。
50名在3个月至20年前接受肾切除术的捐赠者构成了本研究的材料。记录病史（肾切除时捐赠者年龄、肾切除术后时长、家族史）、体格检查，包括人体测量以及肾切除术前和术后的收缩压和舒张压（SBP和DBP）测量。肾功能评估包括肾切除术前和术后的尿液分析、微量白蛋白尿测定、血清肌酐、血尿素、24小时尿蛋白和肌酐估计以及肌酐清除率计算。通过超声测量肾长度。采用标准问卷评估生活质量（QOL）。将患有与肾切除术无关的合并症的捐赠者排除在分析之外。对数据进行统计学分析。
22名捐赠者（44%）为男性，28名（56%）为女性。父母占大多数，为39名（78%）；10名是兄弟姐妹（20%），1名是配偶捐赠者。捐赠时的平均年龄为41.26±8.12岁（25 - 54.16岁）。自肾捐赠以来，平均时间间隔为63个月（3 - 264个月）。SBP平均升高9.96 mmHg，DBP平均升高7.18 mmHg。23名（46%）出现高血压。20名捐赠者（40%）肾切除术后出现微量白蛋白尿（MAU），7名（14%）出现显性蛋白尿（＞300 mg/天）。肾切除术前和术后的平均肾小球滤过率（GFR）分别为102.74±6.91 ml/分钟和74.54±14.64 ml/分钟，平均降低28.2±13.57 ml/分钟。捐赠后血清肌酐无显著变化（0.97±0.09 mg/dl对1.22±0.82 mg/dl）。肾长度增加了1.14±0.73 cm。没有捐赠者后悔捐赠。
本初步研究再次证实了活体肾捐赠的安全性。肾切除术后GFR下降，随之肾长度增加。蛋白尿的轻微增加和血压升高的长期影响需要在更大规模的捐赠者队列中进行更长时间的评估。本研究强调了建立捐赠者登记系统以实现这一目标的必要性。
