In 2 of the 4 studies, there was

a statistically significant increase in albuminuria of about 50 mg/24 hours compared with controls, at a mean of 14 years post-donation.10,17 In the 2 studies that examined the risk of developing microalbuminuria in a total of 67 donors and 51 controls, there was a 3.9-fold increased relative risk of microalbuminuria with donation.7,17,18 There is only one study that has been published (in abstract form only) that examines the long-term outcomes of living kidney donors with elevated levels of proteinuria prior to donation.12 This study prospectively examined 8 donors who pre-donation had a spot urine albumin to creatinine concentration over 10 mg/mmol and/or a spot urine protein to creatinine ratio over 20 mg/mmol. At 1 year post-donation, there was no significant difference in creatinine, blood pressure and inulin clearance compared Napabucasin mouse with ‘normal’ living kidney donors. Studies to date AZD4547 in healthy donors suggest that there is an increased risk of developing proteinuria following living kidney donation. However, the literature is limited by the lack of appropriate control groups, retrospective nature of most published articles, large loss to follow-up of donors, and small sample sizes. The external validity

of their findings is therefore questionable. There is only one study that examined the outcomes of living kidney donors who had elevated levels of proteinuria pre-donation. This study included a small sample size and had a follow-up of only 1 year. In addition,

PAK6 the controls they used were healthy donors rather than healthy non-donors. The suggestions for clinical care are therefore based on the assumption that a potential donor who has proteinuria prior to donating their kidney is likely to develop an increase in the level of proteinuria at least equal to that seen in healthy donors. We also know that proteinuria is a risk factor for the development of kidney failure in the general population and assume that it represents a similar risk in this patient group. As the degree of pre-donation proteinuria that is a risk factor is unknown, we have limited our recommendations to any abnormal amount of proteinuria but have opted to take the upper limit of normal (i.e. 300 mg/24 hours). INTERNATIONAL GUIDELINES: The Amsterdam Forum on the Care of the Living Kidney Donor (2006): A 24 hour urine protein of >300 mg is a contraindication to donation. Microalbuminuria determination may be a more reliable marker of renal disease, but its value as an international standard of evaluation for kidney donors has not been determined. The Canadian Council for Donation and Transplantation (2006): We recommend . . . to refer to existing guidelines regarding the assessment and eligibility of potential living kidney donors (e.g. Amsterdam Forum). European Renal Association-European Dialysis and Transplant Association (2000): Exclusion criteria of donor proteinuria >300 mg/day.