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This case report presents a comprehensive exploration of a complex clinical case involving a 41-year-old male living kidney donor who donated left kidney to his elder sister on 3rd of March 2021. The recipient was a 45-year-old lady with End-Stage Kidney Disease (ESKD) due
to unknown etiology and she is currently doing well with excellent allograft function. The case highlights the intricacies of immunological and neurological complications post-donation, offering valuable insights from the unique clinical scenario at Kenyatta National Hospital, Nairobi, Kenya.
The clinical journey of the patient was meticulously documented, focusing on medical history, familial background, and the trajectory of post-donation complications. Immunological assessments, neuroimaging studies, and therapeutic interventions were analyzed to provide a detailed understanding of the challenges encountered during the patient’s post-donation period. The patient has provided informed consent for the publication of this case report
In June 2021, the patient exhibited proteinuria uACR 119.7 mg/mmol, hematuria, hypertension and an elevation in serum creatinine levels gradually from base line of 85 micromoles/L to 143 micromoles/L. Immunological evaluation revealed persistent progressive PR3 - ANCA positivity of 113.26 RU/ml followed by 164.33 RU/ml, leading to the initiation of enalapril 5mg od mycophenolate mofetil 1g bd and prednisone 60 mg od with tapering . By December 2021, neurological symptoms emerged, and brain MRI confirmed an acute infarct, necessitating therapeutic adjustments, including the introduction of aspirin 75 mg od and atorvastatin 80 mg od. In February 2022, he was switched to Azathioprine 150mg OD and prednisone 5 mg od for the maintenance phase . Repeat PR3 - ANCA done on 29 th September 2022 was negative (4.52 RU/ml); there has been a notable improvement blood pressure, serum creatinine, no hematuria, proteinuria, and absence of neurological signs. Currently he is doing well. Kidney biopsy was not done in this donor due to a relative contraindication of a single kidney.
This case underscores the intricate interplay of immunological and neurological complications in living kidney donors. The significance of vigilant monitoring, timely intervention, and a multidisciplinary approach is highlighted. The findings emphasize the need for ongoing research and increased awareness regarding the potential challenges associated with living kidney donation.