Is a Patient with Paget's Disease of Bone Suitable for Living Kidney Donation?-Decision-Making in Lack of Clinical Evidence

Abstract

Living donor kidney transplantation is a widely performed medical procedure. Living kidney donation requires an in-depth health assessment of candidates. The potential living kidney donor must remain healthy after kidney removal. A consequence of donation can be a decrease in glomerular filtration rate (GFR), and donors can become at risk of developing chronic kidney disease (CKD). We present a rationale for potential living kidney donor withdrawal due to Paget's disease of bone (PDB) based on a literature review. The treatment for PDB includes the use of, for example, non-steroidal anti-inflammatory drugs (NSAIDs), which can lead to acute kidney injury (AKI) as well as CKD, or bisphosphonates, which are not recommended for patients with decreased GFR.

Keywords: Paget’s disease of bone; bisphosphonates; guidelines; living donor kidney transplantation; living kidney donor candidate.

Figure 1

The decision-making flowchart for assessing pre-donation kidney function in a living donor. Conditions subsequently affecting kidneys (e.g., hypertension, diabetes, autoimmune disorders) should be excluded in further evaluation irrespective of the value of the acceptable eGFR (even above 90 mL/min/1.73 m²).

Figure 2

The decision-making flowchart for the living donor suitability assessment. Each step contains two possible answers. Continue if the assumption from every second (brighter) line is met.