{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T22:28:07Z","timestamp":1786573687137,"version":"build-2736575974"},"reference-count":18,"publisher":"Walter de Gruyter GmbH","issue":"2","license":[{"start":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:00:00Z","timestamp":1764547200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/3.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Kidney transplantation is the best choose of modality for treatment of the patients with end-stage kidney disease (ESKD). However, hereditary conditions like COL4 nephropathy introduce significant obstacles in living kidney donor selection. This review presents a real-world clinical dilemma involving a 24-year-old male with autosomal recessive COL4 nephropathy (Alport syndrome) and his 51-year-old mother, a heterozygous carrier. We analyzed the clinical spectrum of COL4 nephropathy in North Macedonia, where 92 patients have been identified via next-generation sequencing (NGS), and COL4A5 mutations were the most prevalent at 67.4%. Because current the kidney disease improving global outcomes (KDIGO) recommendations for living kidney donor evaluation are general and offer scarce guidance for hereditary conditions, we evaluated the recent 2025 ERK Net\/ERA\/ESPN criteria. These updated guidelines suggest that while donation is generally avoided in carriers, it may be considered in highly selected individuals over 40 years of age with preserved kidney function and no subclinical kidney damage on biopsy. Careful and individualized evaluation of potential living donors from affected families is essential. This approach is particularly important in settings with persistent organ shortages and limited access to deceased-donor transplantation.<\/jats:p>","DOI":"10.2478\/bjmg-2025-00022","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T22:52:10Z","timestamp":1778799130000},"page":"25-28","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Living Donor Kidney Transplantation in COL4 Nephropathy - A Real-World Clinical Dilemma in Light of Current Guidelines"],"prefix":"10.2478","volume":"28","author":[{"given":"V","family":"Karanfilovski","sequence":"first","affiliation":[{"name":"University Clinic of Nephrology , Skopje , North Macedonia ."},{"name":"Faculty of Medicine , University \u2018SS Cyril and Methodius\u2019 Skopje , Skopje , North Macedonia ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z","family":"Shterjova Markovska","sequence":"additional","affiliation":[{"name":"University Clinic of Nephrology , Skopje , North Macedonia ."},{"name":"Faculty of Medicine , University \u2018SS Cyril and Methodius\u2019 Skopje , Skopje , North Macedonia ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Canevska Taneska","sequence":"additional","affiliation":[{"name":"University Clinic of Nephrology , Skopje , North Macedonia ."},{"name":"Faculty of Medicine , University \u2018SS Cyril and Methodius\u2019 Skopje , Skopje , North Macedonia ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Tasic","sequence":"additional","affiliation":[{"name":"Faculty of Medicine , University \u2018SS Cyril and Methodius\u2019 Skopje , Skopje , North Macedonia ."},{"name":"University Children Hospital , Skopje , R. North Macedonia ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"Plaseska-Karanfilska","sequence":"additional","affiliation":[{"name":"Research Center for Genetic engineering and Biotechnology\u201d Georgi Efremov\u201d Academy of Science and Arts , Skopje RN Macedonia ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Trpevska Shekerinov","sequence":"additional","affiliation":[{"name":"Faculty of Medicine , University \u2018SS Cyril and Methodius\u2019 Skopje , Skopje , North Macedonia ."},{"name":"University Clinic of Eye disease , Skopje , North Macedonia ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I","family":"Nikolov","sequence":"additional","affiliation":[{"name":"University Clinic of Nephrology , Skopje , North Macedonia ."},{"name":"Faculty of Medicine , University \u2018SS Cyril and Methodius\u2019 Skopje , Skopje , North Macedonia ."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N","family":"Gjorgjievski","sequence":"additional","affiliation":[{"name":"University Clinic of Nephrology , Skopje , North Macedonia ."},{"name":"Faculty of Medicine , University \u2018SS Cyril and Methodius\u2019 Skopje , Skopje , North Macedonia ."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"2026081222021931660_j_bjmg-2025-00022_ref_001","doi-asserted-by":"crossref","unstructured":"Abecassis, M.; Bartlett, S.T.; Collins, A.J.; Davis, C.L.; Delmonico, F.L.; Friedewald, J.; Hays, R.; Howard, A.; Jones, E.; Leichtman, A.B.; et al. Kidney transplantation as primary therapy for end-stage renal disease: A National Kidney Foundation\/Kidney Disease Outcomes Quality Initiative (NKF\/KDOQITM) conference. Clin. J. Am. Soc. Nephrol. 2008, 3, 471\u2013480.","DOI":"10.2215\/CJN.05021107"},{"key":"2026081222021931660_j_bjmg-2025-00022_ref_002","doi-asserted-by":"crossref","unstructured":"Thomas CP, Daloul R, Lentine KL, et al. Genetic evaluation of living kidney donor candidates: A review and recommendations for best practices. Am J Transplant. 2023;23(5):597\u2013607.","DOI":"10.1016\/j.ajt.2023.02.020"},{"key":"2026081222021931660_j_bjmg-2025-00022_ref_003","doi-asserted-by":"crossref","unstructured":"Boenink R, Kramer A, Tuinhout RE, Savoye E, \u00c5sberg A, Idrizi A, et al. Trends in kidney transplantation rate across Europe: study from the ERA Registry. 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Ren Fail. 2017;39(1):290\u2013293.","DOI":"10.1080\/0886022X.2016.1262266"},{"key":"2026081222021931660_j_bjmg-2025-00022_ref_011","doi-asserted-by":"crossref","unstructured":"Boenink R, Bonthuis M, Boerstra BA, Astley ME, Montez de Sousa IR, Helve J, et al. The ERA Registry Annual Report 2022: Epidemiology of kidney replacement therapy in Europe, with a focus on sex comparisons. Clin Kidney J. 2024;18(2):sfae405.","DOI":"10.1093\/ckj\/sfaf107"},{"key":"2026081222021931660_j_bjmg-2025-00022_ref_012","doi-asserted-by":"crossref","unstructured":"Bonthuis M, Kramer A, Bakkalo\u011flu SA, Helve J, Gjorgjievski N, Resic H, \u00c5sberg A, Mitsides N, D\u0119bska-\u015alizie\u0144 AM, Komissarov KS, Kuzema V, Seyahi N, Ponte B, Ziginskiene E, Lausevic M, Rychl\u00edk I, Ots-Rosenberg M, Vazelov E, Moustakas G, Ok\u0161a A, Strakosha A, Garneata L, Katicic D, Torra R, Ortiz A, Stel VS. Incidence and prevalence of kidney replacement therapy in central and eastern europe -trends from the ERA registry. Nephrol Dial Transplant. 2026 Jan 7:gfaf268.","DOI":"10.1093\/ndt\/gfaf268"},{"key":"2026081222021931660_j_bjmg-2025-00022_ref_013","doi-asserted-by":"crossref","unstructured":"Kashtan CE, Ding J, Garosi G, et al. Alport syndrome: a unified classification of genetic disorders of the collagen IV \u03b1345 network. Kidney Int. 2018;93(5):1048\u20131060.","DOI":"10.1016\/j.kint.2017.12.018"},{"key":"2026081222021931660_j_bjmg-2025-00022_ref_014","doi-asserted-by":"crossref","unstructured":"Savige J. Heterozygous pathogenic COL4A3 and COL4A4 variants are common and not typically associated with end-stage kidney failure, hearing loss, or ocular abnormalities. 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