Browse the corpus

©2013 UpToDate ® Print Email Amsterdam forum guidelines for screening living potential kidney donors - 2 Urine analysis for blood Patients with persistent microscopic hematuria should not be considered for kidney donation unless urine cytology and a complete urologic work up are performed. If urological malignancy and stone disease are excluded, a kidney biopsy may be indicated to rule out glomerular pathology, such as IgA nephropathy. Diabetes Individuals with a history of diabetes or fasting blood glucose ≥126 mg/dL (7.0 nmol/L) on at least two occasions (or 2-hr glucose with OGTT ≥200 mg/dL (11.1 mmol/L) should not donate. Stone disease An asymptomatic potential donor with history of a single stone may be suitable for kidney donation if: No hypercalcuria, hyperuricemia, or metabolic acidosis. No cystinuria, or hyperoxaluria. No urinary tract infection. If multiple stones or nephrocalcinosis are not evident on CT. An asymptomatic potential donor with a current single stone may be suitable if: The donor meets the criteria shown previously for single stone formers and current stone <1.5 cm in size, or potentially removable during the transplant. Stone formers who should not donate are those with: Nephrocalcinosis on x-ray or bilateral stone disease. Stone types with high recurrence rates, and are difficult to prevent (see text). Malignancy A prior history of the following malignancies usually excludes live kidney donation: melanoma, testicular cancer, renal cell carcinoma, choriocarcinoma, hematological malignancy, bronchial cancer, breast cancer and monoclonal gammopathy. A prior history of malignancy may only be acceptable for donation if: Prior treatment of the malignancy does not decrease renal reserve or place the donor at increased risk for ESRD. Prior treatment of malignancy does not increase the operative risk of nephrectomy. A prior history of malignancy usually excludes live kidney donation but may be acceptable if: The specific cancer is curable and potential transmission of cancer can reasonably be excluded. Urinary tract infections The donor urine should be sterile prior to donation; asymptomatic bacteria should be treated per donation. Pyuria and hematuria at the proposed time of donation is a contraindication to donation. Unexplained hematuria or pyuria necessitates evaluation for adenovirus, tuberculosis, and cancer. Urinary tuberculosis or cancer are contraindications to donation.

The donor urine should be sterile prior to donation; asymptomatic bacteria should be treated per donation. Pyuria and hematuria at the proposed time of donation is a contraindication to donation. Unexplained hematuria or pyuria necessitates evaluation for adenovirus, tuberculosis, and cancer. Urinary tuberculosis or cancer are contraindications to donation. BP: blood pressure; ABPM: ambulatory blood pressure monitoring; GFR: glomerular filtration rate; BMI: body mass index; BSA: body surface area; CT: computed tomography; ESRD: end-stage renal disease; HLA: human leukocyte antigen. Reproduced with permission from: Delmonico F; Council of the Transplantation Society. A Report of the Amsterdam Forum On the Care of the Live Kidney Donor: Data and Medical Guidelines. Transplantation 2005; 79:S53. Copyright © 2005 Lippincott Williams & Wilkins.