I have donated a kidney and 7 years later I am developing hypertension which I have learnt affects many kidney donors. Why 7 years later and not when the kidney is donated? Exactly what happens to the remaining kidney that causes hypertension so much later and not immediately? I would expect that one larger kidney works better than one small kidney.

High blood pressure (hypertension) can be caused by many things and it is difficult to say that removing a kidney causes hypertension.  Long term follow up studies find an increased incidence of hypertension and small amounts of protein in the urine of people who have donated a kidney in the past, but that does not prove that removing the kidney caused the hypertension.  It is possible that you were destined to develop hypertension in the future.  It may also be that removing kidneys can cause changes in the remaining kidney that over time result in hypertension.  This is something that we do not know at the present time but means that you should get treatment for your hypertension and carefully follow the function in your remaining kidney by annual testing of blood for the estimated glomerular filtration rate (eGFR) and urine testing for blood, protein and infection in the urine.

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