Influence of Proteinuria on Long-Term Transplant Survival in Kidney Transplant Recipients

Hohage, Helge; Kleyer, U; Brückner, Dieter; August, Christian; Zidek, Walter; Spieker, C.

doi:10.1159/000189525

Cited by 68 publications

(49 citation statements)

References 12 publications

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“…31 In addition, observations have confirmed that kidney transplants are particularly vulnerable to the adverse effects of proteinuria. 32 In our cohort, we showed that the risk for proteinuria Ͼ0.5g/d at 1 year increased significantly in patients with a KwRw ratio Ͻ2.3 g/kg, fitting with previous observations that nephron underdosing is a major risk factor for proteinuria.…”

Section: Discussionmentioning

confidence: 97%

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Giral¹,

Foucher²,

Karam³

et al. 2010

Journal of the American Society of Nephrology

117

102

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Long-term function of kidney allografts depends on multiple variables, one of which may be the compatibility in size between the graft and the recipient. Here, we assessed the long-term consequences of the ratio of the weight of the kidney to the weight of the recipient (KwRw ratio) in a multicenter cohort of 1189 patients who received a transplant between 1995 and 2006. The graft filtration rate increased by a mean of 5.74 ml/min between the third and sixth posttransplantation months among patients with a low KwRw ratio (Ͻ2.3 g/kg; P Ͻ 0.0001). In this low KwRw ratio group, the graft filtration rate remained stable between 6 months and 7 years but then decreased at a mean rate of 3.17 ml/min per yr (P Ͻ 0.0001). In addition, low KwRw ratios conferred greater risk for proteinuria, more antihypertensive drugs, and segmental or global glomerulosclerosis. Moreover, a KwRw ratio Ͻ2.3 g/kg associated with a 55% increased risk for transplant failure by 2 years of follow-up. In conclusion, incompatibility between graft and recipient weight is an independent predictor of long-term graft survival, suggesting that avoiding kidney and recipient weight incompatibility may improve late clinical outcome after kidney transplantation.

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Section: Discussionmentioning

confidence: 97%

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Giral¹,

Foucher²,

Karam³

et al. 2010

Journal of the American Society of Nephrology

117

102

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“…The prevalence of proteinuria reported in different studies on adult and pediatric populations varies considerable, from 11 to 82 % [4][5][6][7][8][9][10][11][12][13]. The main reason for this wide variation in prevalence of proteinuria is the different threshold used in these studies to define proteinuria.…”

Section: Prevalence Of Post-transplant Proteinuria and Methods For Itmentioning

confidence: 99%

“…In a pediatric study by Chua et al, 100 % of children had proteinuria at 1 week after RTx; however, it disappeared in 70 % of patients at 8-9 weeks posttransplant [16]. Such transient proteinuria does not have negative impact on long-term graft survival [6][7][8]20]. To the contrary, later onset proteinuria (>2-3 months posttransplant) or persistent proteinuria (duration >3 months) does have a negative impact on long-term graft survival (see below section Clinical consequences).…”

Section: Types Of Post-transplant Proteinuriamentioning

confidence: 99%

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Management of proteinuria in the transplanted patient

Seeman

2014

Pediatr Nephrol

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Proteinuria is a relatively frequent complication in children after renal transplantation (40-80 %). It is usually mild and non-nephrotic in nature and predominantly tubular in origin. The major causes of post-transplant proteinuria are recurrence of primary glomerulonephritis [mostly focal segmental glomerulosclerosis (FSGS)], rejection (acute and chronic), mTOR inhibitors or hypertension. Proteinuria is a risk factor for graft loss and patient death in adults, and even a mild proteinuria (0.1-0.2 g/day) is associated with impaired graft and patient survival. In children, proteinuria seems to be associated with graft but not patient survival. Proteinuria (protein/creatinine ratio) should be assessed regularly in all children. In children with prior chronic kidney disease due to idiopathic FSGS, proteinuria should be assessed daily during the first month after transplantation to enable early diagnosis of recurrence. The cause of proteinuria should be identified, and graft biopsy should be considered in children with unexplained proteinuria, especially with new onset proteinuria or deterioration of previously mild proteinuria. Treatment must be primarily targeted at the cause of proteinuria, and in normotensive children symptomatic antiproteinuric therapy with angiotensinconverting enzyme inhibitors/angiotensin II receptor antagonists should also be initiated. Other antihypertensive drugs should be used to achieve target blood pressure of<75th percentile. Target proteinuria should be <20 mg/mmol creatinine.

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“…Persistent proteinuria is strongly Neale J et al . Cardiovascular risk factors following renal transplant correlated to reduced function and graft survival [146] . In renal transplantation, the presence of proteinuria at 12 mo is associated with a twofold risk of CV death [147] .…”

Section: Proteinuriamentioning

confidence: 99%

Cardiovascular risk factors following renal transplant

Neale

Smith

2015

WJT

118

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Kidney transplantation is the gold-standard treatment for many patients with end-stage renal disease. Renal transplant recipients (RTRs) remain at an increased risk of fatal and non-fatal cardiovascular (CV) events compared to the general population, although rates are lower than those patients on maintenance haemodialysis. Death with a functioning graft is most commonly due to cardiovascular disease (CVD) and therefore this remains an important therapeutic target to prevent graft failure. Conventional CV risk factors such as diabetes, hypertension and renal dysfunction remain a major influence on CVD in RTRs. However it is now recognised that the morbidity and mortality from CVD are not entirely accounted for by these traditional risk-factors. Immunosuppression medications exert a deleterious effect on many of these well-recognised contributors to CVD and are known to exacerbate the probability of developing diabetes, graft dysfunction and hypertension which can all lead on to CVD. Nontraditional CV risk factors such as inflammation and anaemia have been strongly linked to increased CV events in RTRs and should be considered alongside those which are classified as conventional. This review summarises what is known about risk-factors for CVD in RTRs and how, through identification of those which are modifiable, outcomes can be improved. The overall CV risk in RTRs is likely to be multifactorial and a complex interaction between the multiple traditional and non-traditional factors; further studies are required to determine how these may be modified to enhance survival and quality of life in this unique population. Core tip: Cardiovascular disease (CVD) is the leading cause of death and disability in patients following a renal transplant. Identification of risk factors for CVD and strategies for their improvement are required in order to prevent graft failure in this complex patient

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Influence of Proteinuria on Long-Term Transplant Survival in Kidney Transplant Recipients

Cited by 68 publications

References 12 publications

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Management of proteinuria in the transplanted patient

Cardiovascular risk factors following renal transplant

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