Renal Pathological Findings in Living Kidney Donor Candidates with Minimal Urinary Abnormalities
1Medicine-Nephrology, University of Maryland Medical Center, Baltimore, MD, 2Pathology, University of Maryland Medical Center, Baltimore, MD, 3Surgery, University of Maryland Medical Center, Baltimore, MD
Meeting: 2019 American Transplant Congress
Abstract number: B261
Keywords: Biopsy, Donation, Kidney, Proteinuria
Session Information
Date: Sunday, June 2, 2019
Session Name: Poster Session B: Kidney Living Donor: Quality and Selection
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: With the increasing number of ESRD patients requiring transplantation and stagnant number of deceased-donor organs available, minimizing the exclusion of living donor candidates with benign abnormalities is essential. Current guidelines recommend screening for urine albumin rather than protein. Our center protocol is to screen for both albumin and protein, and to perform renal biopsies in patients demonstrating isolated microscopic hematuria or proteinuria <500 mg/24h with normal albuminuria.
*Methods: In this retrospective cohort study, we reviewed the biopsy findings (LM, IF, EM) in 31 donor candidates biopsied between 12/2010 and 10/2018.
*Results: 16 (51.6%) had isolated hematuria, 14 (45.2%) proteinuria, and 1 had both. 27 were female, age was 45.8±12.8, and 20 were Caucasian and 8 African-American. The creatinine clearance was 104.5±21.2 ml/min/1.73m2. Proteinuria ranged from 196-383 mg/24h. Among the 16 patients with hematuria, 12 had thin basement membrane disease, 2 had no abnormal findings, 1 had mild-moderate chronic changes and 2 had glomerular pathology (one with mild C1q nephropathy and one with early Alport’s). Among the 14 patients with proteinuria, 9 had normal biopsies (one with minimal C3 deposition), 2 had mild chronic changes and 2 had glomerular pathologies (one with mild mesangiopathy and one with proliferative GN). The candidate with dual abnormalities had mild chronic changes.
*Conclusions: Our findings suggest that the majority of donor candidates with unexplained isolated microscopic hematuria could have normal or benign changes in the biopsy and do not need to be excluded. Among those with unexplained non-physiological isolated proteinuria <500 mg/24h, a non-trivial number (~15%) could have significant glomerular pathology. Therefore, screening only for albumin excretion could be unsafe for a small but significant portion of candidates. We recommend renal biopsy in healthy donor candidates with unexplained isolated microscopic hematuria or mild proteinuria to avoid exclusion of eligible candidates and acceptance of those with significant pathologies.
To cite this abstract in AMA style:
Ahmed H, Drachenberg C, Ugarte R, Costa N, Cangro C, Barth RN, Weir M, Harirain A. Renal Pathological Findings in Living Kidney Donor Candidates with Minimal Urinary Abnormalities [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-pathological-findings-in-living-kidney-donor-candidates-with-minimal-urinary-abnormalities/. Accessed December 12, 2019.« Back to 2019 American Transplant Congress