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Living Donor Long-Term Risk Counselling — ESENeph MCQ

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EasyTransplantationLiving Donor Long-Term Risk CounsellingESENeph

A 30-year-old woman is being evaluated as a living kidney donor. Her eGFR is 105, BP 115/72, BMI 23, and she has no proteinuria. Her mother has type 2 diabetes. According to KDIGO 2017, what long-term risks should she understand?

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Correct answer: C — Donation approximately doubles the lifetime risk of ESKD (from ~0.03% to ~0.09% in low-risk donors) and may cause a small increase in BP; she must understand these risks even though absolute risk remains very low

KDIGO 2017 living donor guideline requires full informed consent about long-term consequences: (1) the remaining kidney undergoes compensatory hyperfiltration, typically achieving 70% of pre-donation GFR within weeks; (2) lifetime ESKD risk approximately doubles (from ~0.03% to ~0.09% in low-risk donors – still very low); (3) slight increase in BP over decades; (4) pregnancy outcomes are generally good but with slightly increased pre-eclampsia risk; (5) her family history of diabetes is a modest additional risk factor. Lifelong follow-up (annual BP, eGFR, uACR) is recommended. The psychosocial evaluation ensures voluntary, informed decision-making.

Reference: KDIGO 2017 – Living Kidney Donor Evaluation; Muzaale et al 2014 – Donor ESKD Risk