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202 points helsinkiandrew | 1 comments | | HN request time: 0.211s | source
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chithanh ◴[] No.44643879[source]
> What UK Biobank is revealing, scan by scan and layer by layer, is that disease doesn’t arrive out of nowhere. It accumulates quietly, shaped by genes, environment, and habits.

I think that is already known for a while. It's called functional reserve, and was a big topic in HIV patients (and then again for SARS-CoV-2).

Like people with higher cognitive capabilities will be protected by those a bit longer before onset of HIV-associated neurocognitive disorder (or even dementia).

Same for kidneys: They have a functional reserve that you are born with gets used up during life, until it is gone. Acute kidney disease treatment is aimed at preserving whatever little function is left.

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tasty_freeze ◴[] No.44644041[source]
I am a 61 year old guy. I've never been overweight, never smoked, I've never been drunk and drink only infrequently, and have been fitter than average ... sometimes very fit. A few years ago I decided to make an undirected kidney donation. I thought I'd be a slam dunk. Everything was great, except my eGFR (estimate granular filtration rate) was 73, and for many people it is more like 110, which disqualified me, as after donating my number would get cut in half, putting me at some risk.

So I pulled up blood work results going back 15 years that I had records for and found that 73 was my high score! It typically was mid 60s, with a low of 61. I have no idea why it is so low. Anyway, this is the reason I'm relating this story. It seems odd that my kidney function has gone up. It wasn't just a fluke -- I've had bloodwork done at least five times since then and I'm always in the mid 70s now.

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Aurornis ◴[] No.44646250[source]
eGFR is an indirect measurement of kidney function. It can be slightly lower in some people with normal kidney function for various reasons.

There are additional kidney function tests that would be used for a more complete picture of kidney function if it was suspected that you had a kidney condition. There are more direct GFR tests, minus the ‘e’ prefix which means estimated. However, a better blood test that is more accessible would be Cystatin C. Worth getting one of those as a baseline at some point.

In the content of donation, though, it’s not worth risking it. It’s best to play it safe. If you happened to have been inspired by the kidney donation story and blog that circulated in rationalist communities, it’s also worth noting that it was not a great source of information about the relative risks of the procedure, despite being presented as comprehensive and well researched.

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1. tasty_freeze ◴[] No.44653665[source]
The first time I tried a community donation, they didn't do that. But a couple years later one of my brothers needed a kidney, so I got tested again. Again, my eGFR was low 70s, and so they did the Cystatin C test. I scored 1.00 (ref range 0.52-1.23mg/mL) which they mapped to an eGFR of 78, and I was rejected.

None of my other siblings were a good enough match, so one of my sisters donated hers (IIRC, her eGFR was low 90s) as part of a chain. That was more than two years ago and my sister is feeling fine. My brother is no longer on dialysis, though he didn't experience one of those feel-good stories where he got his kidney and he suddenly felt amazing, unfortunately.

[EDIT] I forgot to address the last part of your comment. A few years back an email acquaintance of many years mentioned that he is on dialysis. Although he is in Germany, I said if he can't find a donor, I'd be willing to fly there to donate directly if I matched or to be part of a chain. He is in Germany and his response surprised me: thank you very much, but he said living donations were not allowed (at least from non-relatives). Maybe things have changed, this was back in 2016.

"But there are some reasons that make this solution unlikely. At first I am very sure that this kind of donor isn't allowed in germany. We have strong ethic rules regarding donation by living people because of the bad experiences with commercial organ deals."

Still the idea sat with me. I have donated many gallons of blood and 25 years ago signed up for "be the match" marrow donation that never came to anything, though every few years they send a confirmation letter to make sure my address is still valid. It most charity donations I can write a check and there is a diffuse sense that maybe I incrementally did some good, but giving a kidney has a high probability to make one person's life dramatically better. So that was my motivation.