Is a Patient with Paget’s Disease of Bone Suitable for Living Kidney Donation?—Decision-Making in Lack of Clinical Evidence

Abstract

Living donor kidney transplantation is a widely performed medical procedure. Living kidney donation requires an in-depth health assessment of candidates. The potential living kidney donor must remain healthy after kidney removal. A consequence of donation can be a decrease in glomerular filtration rate (GFR), and donors can become at risk of developing chronic kidney disease (CKD). We present a rationale for potential living kidney donor withdrawal due to Paget’s disease of bone (PDB) based on a literature review. The treatment for PDB includes the use of, for example, non-steroidal anti-inflammatory drugs (NSAIDs), which can lead to acute kidney injury (AKI) as well as CKD, or bisphosphonates, which are not recommended for patients with decreased GFR.

Newly Diagnosed Monostotic Paget’s Disease of Bone during Living Kidney Donor Candidate Evaluation

“…Our patient's case is extremely rare, as he was diagnosed with PDB due to participation in the living kidney donor program, requiring numerous tests. This information led to considerations about the possible future of the patient, who would probably be exposed to painkillers (bone pain) and bisphosphonate (bone pain and bone turnover reduction effect), which could damage his one remaining kidney [3]. Ultimately, the patient was withdrawn from the living-donor kidney program.…”

“…However, there were no indications for treatment due to fracture risk (low MOF and hip fracture probability). The most common treatment of PDB is an intravenous infusion of bisphosphonates, recently zoledronic acid [3,21]. In Poland, zoledronic acid is registered only for treating neoplastic hypercalcemia and preventing fractures/bone complications in oncology patients.…”

“…The above results, which led to PDB diagnosis and the analysis of the benefits and disadvantages of kidney donation as a living donor, resulted in the patient's withdrawal from the living kidney donor program [3]. The patient was referred to the Rheumatology Department for further evaluation and treatment, where he qualified for risedronate use.…”

“…We present a case of a living-kidney donor candidate withdrawal due to monostotic Paget's disease of bone (PDB) with vertebral localization. We have previously published a detailed discussion of the reasons for withdrawal [3].…”