This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The strong demand for living kidney donors has compelled the transplant community to 'push the envelope' of acceptability for donation. Not having data to indicate excessive risk, many centers have accepted for donation candidates who are theoretically less than ideal. The long-term safety of unilateral nephrectomy in marginal candidates is not clear, as studies that have established the safety of the procedure were largely performed on ideal candidates. Although it may be reasonable to allow such donations to proceed, marginal candidates must be watched closely as individuals and as a group. There are several reasons to believe that obese living kidney donors (OLKD's) may be at higher risk for adverse long-term renal complications from unilateral nephrectomy. Obesity has been associated with glomerular hyperfiltration, which can cause glomerulosclerosis, proteinuria and chronic renal failure. In fact, massive obesity has been implicated as a cause of focal segmental glomerulosclerosis, and an obesity-related glomerulopathy has been described and appears to be an emerging epidemic. Because of the apparent importance of hyperfiltration injury in obesity-related renal pathology, an elective 50% reduction of renal mass in obese individuals may be risky. Prior studies that have been cited to support the long-term safety of unilateral nephrectomy do not provide sufficient data to assure safety in OLKD's. No studies of obese donors have been reported, and studies of obese patients with reduced renal mass for other reasons are conflicting. Obese renal allograft recipients (who similarly are faced with a reduced renal mass) do not appear to have decreased graft survival rate compared with non-obese recipients. On the other hand, a study of 73 patients who had undergone unilateral nephrectomy (for tumors or other reasons) found a significantly increased risk of developing renal disease in obese versus non-obese patients. Further studies that examine the long-term safety of live kidney donation from obese individuals are greatly needed. Accurate estimates of long-term risk will help recipients, donors, and transplant teams as they weigh the risk of donation from individual candidates. Given that nearly a quarter of the population is obese, the advisability of donation from obese patients is of critical importance to the supply of living donor kidneys. We propose this study in hopes of providing some critically needed data in this regard. Our hypothesis is that live kidney donation from obese donors increases the individual's risk of adverse renal sequelae. We will recruit the 285 living kidney donors with a BMI of at least 30 kg/m2 who donated at UMMS between 3/96 and 3/02 to undergo health questionnaire and measurement of BP, serum creatinine, and urinary albumin excretion. The primary objective is to determine if there is an increased risk of abnormal urinary albumin excretion (microalbuminuria or frank proteinuria) in OLKD'S as compared to the general population.
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