Pros and cons of live kidney donation in prediabetics: A critical review and way forward

There is shortage of organs,including kidneys,worldwide.Along with deceased kidney transplantation,there is a significant rise in live kidney donation.The prevalence of prediabetes(PD),including impaired fasting glucose and impaired glucose tolerance,is on the rise across the globe.Transplant teams frequently come across prediabetic kidney donors for evaluation.Prediabetics are at risk of diabetes,chronic kidney disease,cardiovascular events,stroke,neuropathy,retinopathy,dementia,depression and nonalcoholic liver disease along with increased risk of all-cause mortality.Unfortunately,most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period.There is lack of prospective long-term studies to know about the real risk of complications after donation.Furthermore,there are variations in recommendations from various guidelines across the globe for donations in prediabetics,leading to more confusion among clinicians.This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients.This review focuses on pathophysiological changes of PD in kidneys,potential complications of PD,other risk factors for development of type 2 diabetes,a review of guidelines for kidney donation,the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.

Chronic kidney disease in children and adolescents in Brunei Darussalam

AIM： To determine epidemiology of Bruneian paediatric chronic kidney disease （CKD） patients and factors that affect growth and progression of disease.METHODS： A cross-sectional study conducted on all children below 18 years old who were diagnosed with CKD over a ten year period （2004 to 2013）. The reference population was all children （〈 18 years old） suffering from CKD and attending the tertiary paediatric nephrology clinic in Brunei Darussalam. Demographic （current age, age of diagnosis, gender, ethnicity）, anthropometric （weight and height）, diagnosis, laboratory data （serum creatinine and haemoglobin, urinalysis） and blood pressure were extracted from the patients’ clinical case notes and recorded using a data collection form.RESULTS： The study revealed a high national prevalence [736 per million child population （pmcp）] and incidence （91 pcmp） of CKD. If CKD was defned at Stage 1, 2, 3, 4 or 5, the associated prevalence fgures were 736, 132, 83, 50 and 33 pmcp. Glomerulonephritis accounted for 69% of all prevalent cases, followed by congenital abnormalities of kidney and urinary tract （20%） and tubulointerstitial diseases （8%）. Minimal change disease being the most common histological diagnosis. The median age of diagnosis was 4.5 years, with congenital disease patients experiencing an earlier onset of diagnosis. A large proportion of patients were below the 5% percentile for height and weight. Non-glomerular diseases, adolescent and female patients were significantly associated with poor growth, but not glomerular filtration rate, age of diagnosis or steroid usage. CONCLUSION： Brunei has a high prevalence of chronic kidney disease in the paediatric population with glome-rulonephritis being the most common disease.