Key words : Transplant, Vascular, Hypertension

Dear Editor,
In the case report by Sun and associates, follow-up of 1 year is not adequate time to comment on the outcome and make recommendations because most complications occur long term.¹ In a previous case, the donor developed fibromuscular dysplasia 8 years after donation.² Rapid progression of native renal artery fibromuscular dysplasia has been reported 1 year after kidney donation.³ In a study of 71 patients with fibromuscular dysplasia and normal blood pressure who were followed for the natural course of disease, 8 (27%) of 30 patients who did not undergo nephrectomy developed hypertension over 7.5 years; in 19 of those who underwent nephrectomy despite fibromuscular dysplasia, 5 (26%) developed hypertension during the following four⁴ years, and this emphasizes the need for long-term follow-up.⁴ Similar results have been observed by others.⁵

Kidney donation may be associated with a major risk of long-term complications, and donors should be thoroughly evaluated for potential secondary complications. Monitoring blood pressure, determining serum creatinine annually, and evaluating for potential proteinuria may improve detection of many disorders at an early stage and may allow intervention before severe damage occurs to the remaining kidney.⁶

References:

1. Sun IO, Hong YA, Kim HG, et al. Successful transplant of a kidney with fibromuscular dysplasia having higher glomerular filtration rate than the contralateral kidney. Exp Clin Transplant. 2012;10(3):290-292.
   CrossRef - PubMed
2. Bonatti H, Harthun NL, Sharma R, Brayman K, Sawyer RG, Hagspiel KD. Fibromuscular dysplasia of the right kidney in a woman who donated her left kidney. Transplant Int. 2010;23(7):e35-e38.
   CrossRef - PubMed
3. Parasuraman R, Attallah N, Venkat KK, et al. Rapid progression of native renal artery fibromuscular dysplasia following kidney donation. Am J Transplant. 2004;4(11):1910-1914.
   CrossRef - PubMed
4. Cragg AH, Smith TP, Thompson BH, et al. Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up. Radiology. 1989;172(1):145-147.
   PubMed
5. Goncharenko V, Gerlock AJ, Jr, Shaff MI, Hollifield JW. Progression of renal artery fibromuscular dysplasia in 42 patients as seen on angiography. Radiology. 1981;139(1):45-51.
   PubMed
6. Schreiber MJ, Pohl MA, Novick AC. The natural history of atherosclerotic and fibrous renal artery disease. Urol Clin North Am. 1984;11(3):383-392.
   PubMed