Management of proteinuria in the transplanted patient

Seeman, Tomáš

doi:10.1007/s00467-014-2876-6

Cited by 13 publications

(7 citation statements)

References 61 publications

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“…Proteinuria can result from miscellaneous causes in a renal transplant patient. Rejection, recurrent or de novo glomerulonephritis, hypertension, obesity, and mTOR inhibitors were suggested causes of proteinuria previously . Rejection and uncontrolled hypertension were the most frequent causes of proteinuria in our study.…”

Section: Discussionsupporting

confidence: 68%

“…Proteinuria is a common complication after renal transplantation, and its prevalence was reported to vary considerably, from 11% to 82% in adult and pediatric populations . In recent years, there has been a growing interest about the impact of proteinuria in these patients and multiple risk factors for proteinuria were reported including acute or chronic rejection, obesity, hypertension, and recurrent or de novo glomerulonephritis …”

Section: Introductionmentioning

confidence: 99%

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Proteinuria in pediatric renal transplant recipients

Yılmaz

Özçakar

Taktak

et al. 2017

Pediatric Transplantation

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Proteinuria has been shown to be an important and potentially treatable risk factor for graft loss. The aim of this study was to evaluate prevalence, etiology, and outcome of proteinuria during the follow-up of children with renal transplantation. We retrospectively reviewed the files of renal transplanted children between 2006 and 2016 in our center. All patients were interpreted with respect to the demographic data and clinical and laboratory features including information about proteinuria. Chi-square test and Mann-Whitney U test were used for analysis. Fifty-two children were eligible for the study. Proteinuria was observed in 34 (65%) and nephrotic range proteinuria was detected in 5 (9.6%) patients. Etiology of proteinuria could be identified in 21 patients. Acute rejection and uncontrolled hypertension were the most frequent causes of proteinuria. Proteinuria had resolved during the follow-up in 59% of the patients. We found that children with and without proteinuria had similar glomerular filtration rate at the end of 50 months of follow-up period. Proteinuria seems to be a common complication in renal transplant recipients. Graft functions can be preserved by immediate evaluation of increasing proteinuria, and by fixing treatable causes rapidly and efficiently during the follow-up in majority of the patients.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Proteinuria in pediatric renal transplant recipients

Yılmaz

Özçakar

Taktak

et al. 2017

Pediatric Transplantation

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“…Therefore, we can speculate that renal transplant recipients do not need systolic BP <120 mm Hg which corresponds in most children with a BP <50th percentile. Another reason for negative result of our trial can be better pharmacological control of proteinuria by ACEIs or ARBs, and proteinuria was present in only 14% of patients at the end of the study which is much lower prevalence than in observational studies (40%‐80%) . It is well known that antihypertensive therapy is much more effective in proteinuric than in non‐proteinuric nephropathies…”

Section: Discussionmentioning

confidence: 74%

“…Besides immunological risk factors for graft survival such as acute/chronic rejection, non‐immunological risk factors play an important role . Arterial hypertension occurs commonly in pediatric patients after KTx (60%‐90%) and is with proteinuria the most significant treatable complication that is associated with impaired graft survival …”

Section: Introductionmentioning

confidence: 99%

Effects of the strict control of blood pressure in pediatric renal transplant recipients—ESCORT trial

Seeman

Vondrák

Dušek

2018

Pediatric Transplantation

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KTx is the best therapeutic modality for pediatric patients with stage five CKD but the long-term allograft survival of the transplanted kidneys is still unsatisfactory. 1 Besides immunological risk factors for graft survival such as acute/chronic rejection, non-immunological risk factors play an important role. 2 Arterial hypertension occurs commonly in pediatric patients after KTx (60%-90%) and is with proteinuria the most significant treatable complication that is associated with impaired graft survival. [3][4][5][6][7] The ESCAPE (effect of strict BP control and ACE inhibition on the progression of chronic renal insufficiency in pediatric patients) trial has clearly demonstrated that strict BP control (BP <50th Abbreviations: ABPM, ambulatory 24-hour blood pressure monitoring; ACEI, angiotensinconverting enzyme inhibitor; ARB, angiotensin receptor blocker; BP, blood pressure; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; ESCORT, effects of strict control of blood pressure in pediatric renal transplant recipients; INTENS, intensified BP Abstract Objectives: Strict BP control can retard progression of CKD in children. This prospective 3-year randomized controlled trial is aimed to investigate whether strict BP control can retard progression of chronic allograft dysfunction. Methods: Twenty-three pediatric patients were randomly selected to the standard BP group (STAND, target 24-hour MAP 50-95th percentile, n = 11) or the intensified BP group (INTENS, target 24-hour MAP <50th percentile, n = 12). The primary endpoint was an annual reduction in eGFR (Schwartz formula, mL/min/1.73 m 2 /y), secondary graft survival, BP, proteinuria, and safety. Results: A total of 21 children (age at entry 11.2 (range 6.2-16.8) years) completed the study, with 73% of children in INTENS and 70% of children in STAND group reached their goal BP. Ambulatory indexed 24-hour MAP decreased significantly in INTENS group (from 0.94 (range 0.86-1.17) to 0.85 (range 0.79-1.01, P < 0.01)) but not in STAND group (from 0.93 (range 0.85-1.07) to 0.90 (range 0.84-1.01)). Proteinuria did not change significantly in either group (22.1 mg/mmol creatinine to 15.3 in STAND group vs 25.7 to 11.8 in INTENS group). The annual reduction in eGFR did not differ between the INTENS and STAND groups (−1.9 mL/min/1.73 m 2 /y (range +6.4 to −14.3) vs −0.9 (range +4.0 to −8.5)). Conclusion:This first randomized controlled trial on strict BP control has demonstrated that strict BP control is feasible in 73% of children but the strict BP control does not lead to retardation of graft function decline in comparison with standard BP control. However, the results need to be interpreted with caution keeping the major limitation of the study, that is, small sample size in mind. K E Y W O R D S blood pressure, children, hypertension, kidney transplantation, proteinuria Graft function 60 62 64 66 68 70 72 74 76 78 80 1 2 3 4

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“…[ 4 ] Proteinuria after kidney transplantation is common and is associated with reduced allograft survival. [ 5 6 ] A thorough systematic review of RAS inhibitors in kidney transplantation demonstrated reductions in proteinuria, hematocrit, and glomerular filtration rate in renal transplant recipients with RAS inhibitors. [ 7 ] However, there was insufficient data to determine the effect on patient or graft survival.…”

Section: Introductionmentioning

confidence: 99%

The effect of renin-angiotensin system inhibitors on kidney allograft survival: A systematic review and meta-analysis

et al. 2016

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Background:The use of renin-angiotensin system (RAS) inhibitors in patients with chronic kidney disease, and especially in diabetic kidney disease, has been shown to provide renoprotective effects and slow progression to end-stage renal disease. However, this protective effect in kidney transplant patient populations is unclear.Aim:The objective of this systematic review and meta-analysis was to evaluate the effect of RAS inhibitors on kidney allograft survival.Materials and Methods:A literature search for randomized controlled trials (RCTs) was performed from inception through February 2016. Studies that reported relative risks or hazard ratios comparing the risks of renal graft loss in renal transplant recipients who received RAS inhibitors vs. controls were included. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance method.Results:Five studies (3 RCTs and 2 cohort studies) with 20024 kidney transplant patients were included in the meta-analysis. Pooled RR of allograft failure in recipients who received RAS inhibitors was 0.73 (95% CI: 0.45–1.21). When meta-analysis was limited only to RCTs, the pooled RR of allograft failure in patients using RAS inhibitors was 0.59 (95%: CI 0.20–1.69). The risk for mortality (RR: 1.13 [95% CI: 0.62–2.07]) in patients using RAS inhibitors compared to controls was not significantly reduced.Conclusion:This meta-analysis demonstrated insignificant reduced risks of renal graft loss among renal transplant recipients who received RAS inhibitors. Future studies assessing the potential benefits of RAS inhibitors on allograft survival in specific kidney transplant patient populations are needed.

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Management of proteinuria in the transplanted patient

Cited by 13 publications

References 61 publications

Proteinuria in pediatric renal transplant recipients

Proteinuria in pediatric renal transplant recipients

Effects of the strict control of blood pressure in pediatric renal transplant recipients—ESCORT trial

The effect of renin-angiotensin system inhibitors on kidney allograft survival: A systematic review and meta-analysis

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