0022-534 7/88/1404-0810$02.00/0 THE JOURNAL OF UROLOGY Copyright © 1988 by The Williams & Wilkins Co. Vol. 140, October Printed in U.S.A. RENAL FUNCTION 27 YEARS AFTER UNILATERAL NEPHRECTOMY FOR RELATED DONOR KIDNEY TRANSPLANTATION LAWRENCE L. BOHANNON,* JOHN M. BARRY, DOUGLAS J. NORMAN AND WILLIAM M. BENNETTt From the Renal Transplant Service, Divisions of Nephrology and Urology, The Oregon Health Sciences University, Portland, Oregon ABSTRACT Renal function in a living related kidney donor was evaluated 27 years after unilateral nephrec- tomy. The patient was normotensive and had no significant proteinuria. Creatinine was 0.8 mg. per dl. and creatinine clearance was 88 ml. per minute per 1. 73 m. 2 or 152 per cent of the single kidney pre-nephrectomy value. Tubular function assessed by the ability to lower urinary pH in response to an acid load was normal. Biopsy of the transplanted kidney 18 years after donation was histologically normal. This case represents one of the longest followup evaluations of a living related donor reported to date and it argues against any adverse effects of organ donation on the function of the remaining kidney. (J. Ural., 140: 810-811, 1988) The productive lives of many individuals with end stage renal disease have been extended because a living relative donated a kidney for transplantation. Recipients of living related donor kidneys fare significantly better than their cadaveric recipient counterparts in terms of patient and graft survival, and inci- dence of complications. Concerns about the long-term conse- quences of renal donation have recently arisen because of experimental evidence documenting glomerular hyperfiltration with increased intraglomerular pressures as a result of ablation of a renal mass. 1 Indeed, urinary albumin excretion is increased compared to age-matched controls in kidney donors studied 9 to 15 years after donation. 2 Development of renal dysfunction has not been observed and although hypertension develops in some patients its prevalence is not greater than the general population. 3 - 5 However, since living related donors tend to be in the third and fourth decades of life, followup periods even as long as 10 to 20 years may be insufficient to observe clinical evidence of decreased renal function. We report a detailed evaluation of a woman who donated a kidney for transplanta- tion 27 years ago. She was the first living, related kidney donor at the Oregon Health Sciences University in October 1959. CASE REPORT C. C., a 39-year-old white woman, had undergone left donor nephrectomy on October 9, 1959 when she was 12 years old to provide an isograft for her identical twin sister C. W. C. W. had end stage disease secondary to chronic glomerulonephritis. Before nephrectomy C. C. underwent a complete medical eval- uation, including an excretory urogram (normal) and a 12-hour creatinine clearance (116 ml. per minute per 1.73 m. 2 ). Pre- nephrectomy serum creatinine was 0.9 mg./dl. (normal 0.5 to 1.2). The operation was uncomplicated and the renal isograft has functioned well in C. W. without major problems. In 1977, 18 years after transplantation, C. W. underwent an open renal biopsy to evaluate microhematuria without proteinuria. Light microscopy of the transplanted kidney biopsy showed approx - imately 40 glomeruli that were normal. The interstitium showed no infiltrates or fibrosis_ There were no vascular lesions. The microhematuria was believed to be secondary to a papilloma at Accepted for publication January 28, 1988. * Current address: Department of Nephrology, Presbyterian Medical Center, P. 0. Box 7999, San Francisco, California 94120. t Requests for reprints: Department of Medicine, Division of Ne- phrology and Hypertension, The Oregon Health Sciences University, 3181 S. W. Sam Jackson Park Rd., L463, Portland, Oregon 97201. the left ureteral orifice, which was subsequently demonstrated on cystoscopy. C. C. was admitted to the Clinical Research Center at the Oregon Health Sciences University. She was a well developed, well nourished, 39-year-old woman who appeared to be in good health. She ate a normal diet without restriction of dietary protein or phosphate. Medical history was notable for allergies to penicillin and sulfa, 2 normal pregnancies and a total abdom - inal hysterectomy in 1976. Physical examination revealed height 161 cm., weight 71.4 kg., body surface area 1.82 m. 2 and blood pressure 100/80. The rest of the examination was unre- markable except for the left nephrectomy and the midline hysterectomy scars. Laboratory examination showed blood urea nitrogen 16 mg./dl. (normal 10 to 20), creatinine 0.8 mg./dl., potassium 4.4 mg./dl. (normal 3.5 to 5.0), calcium 9.0 mg./dl. (normal 8.5 to 10.0), phosphate 2.7 mg./dl. (normal 2.3 to 4.0), albumin 4.0 gm.fl. (normal 3.6 to 5.0), white blood count 5,400/ mm. 3 (normal 5,000 to 10,000) and hematocrit 41.7 per cent (normal 38 to 43). Renal function data are shown in the table. A renal scan showed normal perfusion and glomerular and tubular function of the remaining right kidney. Ultrasound revealed a 12.2 X 6.1 cm. kidney. Inulin and paraaminohippuric acid clearances were 80 (normal 90 to 110) and 459 (normal 400 to 600) ml. per minute per 1.73 m.2, respectively. Acid loading with ammonium chloride (0.1 gm./kg.) caused a de- crease in the urine pH for 6 hours from 7.33 to 5.09 (normal less than 5.2 for 6 hours) and a decrease in the serum bicarbon- ate from 29 to 20 mmol./1. (normal 25 to 29). DISCUSSION Our 39 year-old renal donor remains in excellent health 27 years after unilateral nephrectomy. Blood pressure, serum elec- trolytes and 24- hour protein excretion are normal. Creatinine clearance is 75.9 per cent of the pre-nephrectomy determina- Pt. age (yrs.) Blood pressure (mm. Hg) Creatinine (mg.fell.) Creatinine clearance (ml./min./1. 73 m.2) Inulin clearance (ml./min./1. 73 m.2) Paraaminohippuric acid clearance (ml./ min./1. 73 m. 2 ) Inulin/paraaminohippuric acid clearance ratio 24-hr. urine protein (mg.) 1959 1986 12 120/70 0.9 116 <150 39 100/80 0.8 88 76.2 437.1 0.17 <150