Abstract
Background and Aims
Potential kidney donors with isolated hematuria are often excluded from donating although there is a wide controversy about the definition and threshold of investigations or exclusion form donation. Many centers use the cut off of > 3 RBC in men and > 5 RBC in women. Some centers consider positive dipstick on urinalysis as the definition of microscopic hematuria. Kidney biopsy in these donors can be borderline and inconclusive. We conducted a short survey about the suitability of these marginal living kidney donors with microscopic hematuria.
Method
This is a cross-sectional survey of nephrologists and transplant surgeons (TS) about suitability and acceptance of marginal live kidney donors with isolated microscopic hematuria. The question was about a 35-yr. old man non-smoker with isolated microscopic hematuria (4 RBC on repeated UA and trace hematuria on dipstick) and negative imaging. The survey was mainly distributed through American Society of Transplantation, American Society of Transplant Surgeons and European Renal Association-European Dialysis and Transplant Association. In-training nephrologists or transplant surgeons were excluded.
Results
A total of (n= 122 from 22 countries, 80% nephrologists and 20% TS) responded to the survey. Most respondents were experienced in donor evaluation (72% of physicians have over 6 years’ experience and 68.5% of them perform donors’ evaluation on weekly or monthly bases). Interestingly, at this low level of microscopic hematuria (4 RBC on repeated UA and trace hematuria on dipstick) only very limited number of respondents (7.5%) would allow donation without further work up. Instead, most respondents (n= 75, 63%) would ask for kidney biopsy prior to taking further steps. Many physicians (n=35, 29%) choose to ask for an alternative donor to avoid the hassle of kidney biopsy which may not change the management. There was no difference in acceptance rate for donors between TS and nephrologists (7.2% versus 8.3% respectively, p=NS), requesting kidney biopsy (63.9% vs. 62.5%) or in declining these donors (28.8% versus 29.1%, p=NS).
Conclusion
Young kidney donors with persistent isolated microscopic hematuria (even at mild degree) require further evaluation with kidney biopsy before donation. However up to one third of the nephrologist and transplant surgeon will ask for an alternative donor to avoid the hassle of kidney biopsy which can be borderline or inconclusive.
Persistent Asymptomatic Isolated Microscopic Hematuria in Israeli Adolescents and Young Adults and Risk for End-Stage Renal Disease
