Incidental nephrolithiasis in live related kidney Donors: epidemiology, long term outcome of donor and recipient.
Sources of Funding: None
Introduction
The use of computerized tomography angiography for donor evaluation has resulted in the increased detection of incidental nephrolithiasis in living renal donor candidates. This study aims at reporting the epidemiology of asymptomatic renal stones in healthy live related potential donors as well as the management strategy and long-term outcome of kidney recipients with asymptomatic stones in donors.
Methods
2200 potential donors, between 2000 and 2015 were evaluated for the presence of asymptomatic renal stones. They were subjected to abbreviated metabolic panel for stone disease along with a detailed clinical history. Donors with stones > 15 mm, significant metabolic abnormalities and presence of associated risk factors for recurrent stone disease were rejected. Finally, 36 donors with stones, proceeded for donation with stone size of 2-15 mm (group I: stone ? 4 mm, n=17; Group II: stone 5-15 mm, n=19). Patients of group I were accepted for donation with stones in situ whereas, patients of group II were treated for stones prior to donation. Records were analyzed for recipient outcome, with special attention to stone events, as well outcome of donors in terms of stone recurrence in residual kidney.
Results
Prevalence of asymptomatic renal stone in potential donors was 4.2 %. Mean age of the donor was 42.5±10.5 years with mean GFR of the transplanted kidney being 38±5.5 ml/min. In group I, follow up imaging revealed seven, four and one patients had residual stones (all ? 4 mm) at 1 month, 3 month and one year respectively. Similarly, in group II, five, three and one patient had residual stones (?6 mm). Except one, none of the recipients had stone related events in post transplant period. One patient of group II required ureteroscopic stone retrieval in post transplant period. The mean serum creatinine of the recipients at 3 months and one year was (1±0.25) mg/dl and (1.45±0.4) mg/d respectivelyl. With a mean follow up of 6.5 years, donors did not show any stone recurrence in the residual kidney.
Conclusions
Transplantation of kidneys with small, asymptomatic renal stones in situ can be safely done with adequate post-operative follow up. Donors that donated the stone-bearing kidney fared equally well in terms of recurrence of stone in residual kidney.
Funding
None
Aneesh Srivastava
Uday Singh
Rakesh Kapoor
M S Ansari
Sandeep Kumar