To study post nephrectomy biochemical and clinical follow up of living related donors. Living related kidney donors who had donated their kidneys in the period between 1986 to 2002 were asked to attend a dedicated donor follow-up clinic regularly starting in year 2000. There were 2 cross sectional recalls in 1994 and 1997 before this period. In the dedicated clinic donors have been followed monthly for 6 months, thereafter 6 monthly for 1 year and then yearly. All kidney donors were subjected to a detailed physical examination, a complete biochemistry and haematology analysis along with urine metabolic studies and ultrasound scan of the remaining kidney. Donor demography, rehabilitation, post nephrectomy change in weight, development of Hypertension and Diabetes Mellitus, status of renal function, lipid levels, total caloric and protein intake and any serious illness in the intervening period were noted. All donors were also questioned about their emotional feelings on donating a kidney. Seven hundred and thirty-six donors had complete evaluation. The mean age of donors was 37 ± 11 years with a mean follow-up 4.8 ± 3 years. The mean pre and post nephrectomy parameters were creatinine 0.97 ± 0.1 vs 0.97 ± 0.12 mg/dl, albumin 4.2 ± 0.4 vs 4.4 ± 0.2 g/dl, creatinine clearance 92 ± 15 vs 86 ± 25 ml/min and urinary protein 102 ± 32 vs 110 ± 65 mg/24 hours. Creatinine clearance of < 60 ml/min was observed in 7% of donors and proteinuria exceeding 300 mg/24 hrs was noted in 5% of donors. 76 (10%) of donors became hypertensive. Prevalence of hypertension and abnormal proteinuria was higher in donors with post nephrectomy duration exceeding 10 years. 290 (39%) patients became either overweight or obese. Diabetes mellitus developed in 26 (3.5%) and was more common in patients with significant weight gain. All kidney donors had voluntarily donated their organs and for emotional reasons. Renal function was well preserved, majority were rehabilitated and had not encountered any serious health problems in the intervening period.