Post Renal Transplant Follow Up in Focal Segmental Glomerulosclerosis with 24 Hour Urine Protein Collection - Traditional and True

Abstract

Urinary protein excretion is crucial to both diagnosis and treatment of many renal disorders as also critical for follow up of kidney allograft function after transplant. Random Urine Protein Creatinine Ratio (PCR) is commonly used to estimate proteinuria. However, there are concerns over diagnostic accuracy of PCR or its correlation with the extent of proteinuria noted on 24 hour urine collection (24-UP). We present a case of a 38 years old Caucasian man with history of end stage renal disease due to primary focal segmental glomerulosclerosis (FSGS). He underwent a deceased donor kidney transplant with immunosuppressive induction and maintenance per hospital protocol. His creatinine and proteinuria as measured by PCR improved progressively. With discharge planning underway, we tested a 24-UP. Unexpectedly, his 24 hour proteinuria was markedly higher than that suggested by the PCR calculated on a spot urine sample. A diagnosis of early recurrence of FSGS was made and the patient was successfully treated with plasmapheresis. In addition, his tacrolimus was changed to cyclosporine. We conclude that it is prudent to routinely monitor proteinuria by timed urine collection in the immediate post-transplant setting for recipients with primary FSGS to avoid delays on appropriate therapy that could impact graft function and survival.