In a single study of

donors who had a 24-hour urine protein excretion between 150 mg and 300 mg, the simultaneous estimation of urinary albumin excretion was normal in all individuals.14 No follow-up, however, was provided to determine which factor proved to be the superior risk marker. The effect of the addition of proteinuria with other renal and cardiovascular risk factors is uncertain. There is limited literature on this topic but it is assumed that there would see more be an incremental rise in the adverse long-term outcome of living kidney donors with every additional risk factor. The size of this incremental rise is unknown. Databases searched: MeSH terms and text words for kidney transplantation were combined with MeSH terms and text words for living donor and with MeSH terms and text words for hematuria, proteinuria, and albuminuria, combined with the Cochrane highly sensitive search strategy for

prognosis questions. The search was carried out in Medline (1966 – January Week 2, 2008). The Cochrane Renal Group Trials Register was also searched for trials not indexed in Medline. Date of search/es: 15 January 2008. Due to the limited information on the outcome in living kidney donors with pre-donation proteinuria, we commenced our review by examining the effect of donation on proteinuria in healthy living kidney donors (i.e. normal blood pressure, GFR > 80 mL/min and normal amount of proteinuria pre-donation). There are more than 40 studies that STA-9090 describe the development of proteinuria following living kidney donation in donors who had ‘normal’ levels of proteinuria pre-operatively.7 The key studies include a study that followed 70, out of a possible 180 donors, over 20 years following nephrectomy.15

These authors discovered 19% of donors had a protein excretion of over 150 mg/24 hours and 7% had greater than 800 mg/24 hours. Fehrman-Ekholm et al. described Interleukin-3 receptor 348 Swedish living kidney donors a mean of 12 years post-donation.16 They detected ‘slight’ proteinuria (<1.0 g/L) in 9% and ‘significant’ proteinuria (≥1.0 g/L) in 3% of donors. There was a significant association between proteinuria and increased blood pressure (P < 0.01) and lower glomerular filtration rate (P < 0.05). There are 3 published articles that examined the long-term outcome of proteinuria in donors compared with controls.8–10 They compared a total of 129 donors with 83 control subjects, with a mean follow-up of 11 years after donation. Two of the 3 papers detected a statistically significant increase in proteinuria in the donors compared with the control. On pooling the results, the weighted average increase in proteinuria in living kidney donors was 66 mg/24 hours compared with controls (95% CI: 24 mg/24 hours, 108 mg/24 hours).