Aly Haider.
Careful Selection of Donors for Renal Transplantation.
J Coll Physicians Surg Pak Jan ;10(5):187-9.

Meticulous screening and selection of renal donors is of primary importance especially when the donor has a strong family history of hypertension, ischaemic heart disease or diabetes mellitus. Given here under is a case report of a 40-year-old male who developed hypertension within a year of donating a kidney to his sister and died due to hypertension-related complications in a decade. This interesting example emphasize upon the importance of careful selection of donors, to avoid medical and ethical dilemmas after renal donation.

CASE REPORT: A 40-year-old male labourer, father of three children was admitted to the nephrology unit, JPMC with grade IV dyspnoea, generalized oedema and drowsiness for 4-5 days. He had donated his right kidney (unilateral nephrectomy) to his sister about 10 years ago. An year later, he developed hypertension for which he was on anti-hypertensive drugs including calcium antagonist, ACE inhibitors and diuretics albeit irregularly with irregular follow-up in the OPD. This young patient had a strong family history of coronary artery disease (CAD) and hypertension with his father dying of `stroke` and mother being alive and hypertensive. A brother had died early due to myocardial infarction and one sister had developed ESRD due to analgesic abuse and was the recipient of his kidney.On examination, the patient was breathless with respiratory severely anaemic. His urine output was 800 ml/24 hrs. Chest rate of 30/min, BP 130/100, Pulse 130/min, JVP normal and was clear, heart sounds were pure and abdomen revealed a nephrectomy scar in the right lumbar region. Na+ 127.3 mEq/L, K+ 5.10 mEq/L, CI 90.9 mEq/L, Bicarbonate 10 mEq/L, Hb 7,99%, Urea 26 mg % and Cr 10.02 mg%. Urine D/R showed SPGR 1010, Sugar Nil, WBC 4-6/HPF, RBC 2-4/HPF, HbsAg +ve. Twenty-four hours urine volume was 800 ml, protein A diagnosis of acute and chronic renal failure due to hypertension was made. He was hemodialysed twice in the following 24 hours with some improvement in acidosis and consciousness level. However, on day 5 of admission he developed right side hemiplegia with a GCS of 6/15,BP 90/60, Pulse 85/min and R/R of 20/min. There was areflexia, hypotonia and extensor plantar on the affected side and he died 4 hours later.

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