Lupus after kidney donation to an affected male relative.

We report a case of lupus occurring in a 52 year-old woman approximately 2 years after donating a kidney to her brother who had end-stage-renal-disease on the basis of lupus nephritis (LN). At the time of donation, the patient had been asymptomatic with a normal physical examination, laboratory and imaging studies. At the time of her diagnosis of lupus she was found to be ANA negative but positive for anti-double stranded DNA. Testing for markers of autoimmune disease was not performed prior to donation. There is little guidance in the literature on risk stratification for potential living kidney donors with a family history of systemic lupus erythematosus (SLE) and LN. The utility of routine ANA testing for all potential kidney donors is limited however it may help inform the risk-assessment of possible donors with a family history of SLE. We suggest that ANA screening be done for all potential kidney donors with first-degree relatives who have SLE. More complete screening for autoimmune markers and greater caution should be used when assessing potential kidney donors with SLE-affected first-degree male relatives.