Significance of Urinary Microscopy and Renal Biopsy in the Evaluation of Living Donors Before Transplantation

Abstract

The case histories of three prospective donors for kidney transplantation including one identical twin are presented. They had all been in perfect health and physical examination including radiological studies of the kidneys and chemical testing of the urine were normal. In all of them a scrupulous urinary microscopy revealed a sparse pathological sediment mainly consisting of casts. In two cases renal biopsy showed a moderate degree of chronic glomerulonephritis. The third individual was moderately hypertensive and renal biopsy showed arteriosclerosis. In addition microscopy of the urine strongly suggested chronic pyelonephritis. Therefore, all of them had to be excluded as kidney donors. It is emphasised that all kind of kidney diseases including glomerulonephritis may exist without proteinuria and with a pathological sediment as the only clinical sign. This implies the great significance of urinary microscopy in general and particularly in the evaluation of prospective living donors, in whom kidney disease has to be ruled out by any possible means, if necessary also by including a percutaneous renal biopsy.