What are the implications of these imaging findings for a potential living kidney donor with normal laboratory and urine results?

Evaluation of Imaging Findings for a Potential Living Kidney Donor

Based on the imaging findings provided, this potential donor has favorable renal anatomy and appears to be an acceptable candidate for kidney donation from an anatomical perspective, assuming their normal labs and urine results remain stable.

Anatomical Assessment

The imaging results show several favorable characteristics for kidney donation:

• Kidney Size: Both kidneys are of adequate size (left 11 cm, right 12 cm), which is within normal range
• Vascular Anatomy:
  • Single renal artery on each side without early bifurcation
  • Single renal vein on each side without late confluence
  • This simple vascular anatomy is optimal for surgical planning 1
• Collecting System: Single ureter on each side with no hydronephrosis
• Absence of Pathology:
  • No kidney stones
  • No masses
  • No evidence of cysts or other parenchymal abnormalities

Interpretation in Context of Donor Evaluation Guidelines

The imaging findings meet the criteria for anatomical suitability according to established guidelines:

1. Normal Renal Anatomy: The absence of significant anatomical variants reduces surgical risks 1

2. No Contraindications: The imaging shows none of the contraindications specified in guidelines, such as:

   • No significant unilateral renal atrophy
   • No horseshoe kidney
   • No significant cortical scarring
   • No cysts (2-3 cysts in each kidney would be concerning)
   • No angiomyolipoma
   • No significant atherosclerotic disease
   • No fibromuscular dysplasia 1

3. Normal Collecting System: No abnormalities that would preclude donation 1

Additional Considerations Beyond Imaging

While the imaging findings are favorable, comprehensive donor evaluation requires:

1. Renal Function Assessment:

   • The normal labs mentioned are reassuring
   • Guidelines recommend GFR ≥90 mL/min/1.73m² for donation 1
   • 24-hour urine collection for creatinine clearance and proteinuria assessment is standard 1

2. Urinalysis Evaluation:

   • The normal urine results mentioned are reassuring
   • Absence of proteinuria/albuminuria is essential
   • KDIGO guidelines recommend measuring albuminuria with ACR <30 mg/day being acceptable 1

3. Stone Risk Assessment:

   • The absence of stones on imaging is favorable
   • Even with normal imaging, history of stones should be assessed 1

Surgical Planning Considerations

The imaging findings suggest either kidney could be used for donation:

• The right kidney is slightly larger (12 cm vs 11 cm)
• Both kidneys have favorable vascular anatomy
• If all other factors are equal, some centers prefer to leave the larger kidney with the donor

Conclusion

From an anatomical perspective based on imaging alone, this potential donor appears to be an excellent candidate for kidney donation, with normal kidney size, simple vascular anatomy, and no evidence of pathology that would preclude donation. The normal laboratory and urine results further support candidacy, though comprehensive evaluation including GFR measurement, albuminuria quantification, and psychosocial assessment would still be required to complete the evaluation process.