Kidney and bladder disease - Whole blood and components

Pyelonephritis: acute nephritis due to ascending infection.

Acute tubular interstitial nephritis: acute nephritis caused by an 'allergic reaction' to medication, rarely as part of a systemic often autoimmune disease.

Glomerulonephritis: May be primary intrinsic to the kidney or secondary, associated with certain infections, drugs, systemic disorders (SLE, vasculitis), or diabetes.

If well, on no treatment, and is discharged from follow-up, accept.

• Autoimmune disease

Self-limiting renal disease (e.g. single attacks of glomerulonephritis or pyelitis), from which recovery has been complete, do not necessarily disqualify the donor.

If there is doubt about the diagnosis, refer to a Designated Clinical Support Officer.

If the donor has taken a single dose of an antibiotic after sexual intercourse to prevent urinary tract infection, is symptom-free on the day of donation, and does not have an underlying condition that prevents donation, accept.

• Antibiotic therapy

Donors may be taking prophylactic antibiotics long-term or as single post-coital doses. Anatomical anomalies within the urinary tract can make individuals more prone to recurrent infections. If a donor is accepted in accordance with the Discretionary guidance above, the importance of informing the relevant blood service of symptoms suggestive of urinary tract infection occurring within 14 days of donation must be emphasised with the donor.

Donors on long-term antibiotics may have ongoing urinary tract infection without having any symptoms. As an active infection at the time of donation cannot be ruled out, these donors must not be accepted.

If a kidney transplant was of a non-stored autologous organ, accept.

• Autoimmune disease
• Blood pressure, high
• Diabetes mellitus
• Immunodeficiency
• Tissue and organ recipients

If treated with blood or blood products, immunoglobulin, plasma exchange or filtration:

Transfusion

People with significant kidney failure usually have a high risk of anaemia. This, together with other factors, make them unsuitable as donors.

A diagnosis of polycystic kidney disease does not necessarily prevent donation. If otherwise well, accept.

• Blood pressure, high
• Infection, general
• Kidney failure above

Polycystic kidney disease is usually genetic. It varies markedly in its severity and many people will not run into problems until later in their lives. Before this happens, provided they are otherwise well, there is no reason why affected individuals should not donate. Often they will have higher haemoglobin concentrations than normal.

• Infection, general

Renal colic is most commonly caused by solid material (crystals or a stone) passing through the tube that connects the kidney to the bladder (the ureter). It is commonly associated with infection.

It is important to wait until the donor is fully recovered and any investigations have been completed. This should avoid a donation being taken from an individual with infection. Infection can lead to bacteria contaminating any donated material. This can be dangerous because bacteria can multiply to dangerous levels in the stored donation.

Kidney and bladder stones have many causes and may be associated with infection. It is important to ensure that there is not an underlying cause that would prevent donation.

If investigations are complete, there are no associated conditions or treatments which would prevent donation, symptoms are controlled even if on medication other than pentosan polysulfate sodium (Elmiron®), the potential donor has not required catheterisation within the last 7 days, and any treatment with pentosan polysulfate sodium (Elmiron®) as completed more than 7 days ago, accept.

• Autoimmune disease
• Chronic fatigue syndrome
• Endoscopy
• Infection, general
• Surgery
• Urinary catheterisation

Interstitial cystitis (IC) or painful bladder syndrome (PBS) is a condition which causes chronic or recurrent pain in the bladder and in the pelvic region due to damaged bladder lining or urothelium.

The cause is unknown but may be associated with other conditions such as irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, autoimmune disease and anxiety disorder. It may also be caused by traumatic injury to the bladder and precipitated by infection.

The diagnosis of IC or PBS is one of exclusion.

Treatment can be through diet modification, bladder training techniques, exercise and stress management. It can include oral medication with analgesics, antidepressants, and cimetidine. Treatment can also be with pentosan polysulfate sodium (Elmiron®) which can be associated with increased bleeding and bruising. The condition can also be treated by interventional methods including catheterisation, surgery and botulinum toxin injections.

Investigation and treatment can involve cystoscopy. Use of neuromodulation techniques with a transcutaneous electrical nerve stimulation (TENS) machine does not prevent donation.