What is the accepted guideline for living kidney donors in regards to history of hematuria? in this case its episodic hematuria in a marathon runner, BUT also has low levels proteinuria, no other risk factors very healthy 2- Would anyone say this is not an optimal donor? what are his potential risks if donating a kidney?
The patient you describe would not be considered optimal by most transplant centers. The presence of proteinuria, in particular, would be seen as an indicator of increased risk and possible underlying renal disease such as IgA nephropathy or Alport’s nephropathy. If he/she is highly motivated to donate and has clearly normal GFR it would be reasonable to offer to clarify the situation with a careful evaluation. This would include serial (at least 3) tests for microhematuria/glomerular RBCs, 1 or more 24 hour urine collections for total protein and albumin, imaging (e.g. CT urography) and, possibly, a renal biopsy with immunofluoresence and electron microscopy. Microhematuria alone with normal imaging and normal histology or thin basement membrane disease with no family history of end-stage renal disease (ESRD) could be seen as a minimal risk situation – some centers would be comfortable proceeding with donation. Confirmation of abnormal albuminuria with or without any other pathological diagnosis would be clear grounds for refusing donation and, possibly, advising future follow-up with a nephrologist. In this case donation would, almost certainly, be associated with increased or accelerated risk of future hypertension, chronic kidney disease and ESRD although the literature does not contain enough data to provide accurate figures. A nice presentation and discussion on this topic can be found in Vadivel et al Kidney Int 2007; 71: 173–177.