Posttransplantation Proteinuria

Shamseddin, M. Khaled; Knoll, Greg

doi:10.2215/cjn.01310211

Cited by 55 publications

(55 citation statements)

References 58 publications

(86 reference statements)

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“…30 Proteinuria was graded as absent (#0.3 g/24 h), mild (.0.3-1.0 g/24 h), moderate (.1.0-3.0 g/24 h), and severe (.3.0 g/24 h). 7 Renal allograft function (eGFR) was estimated using the four-variable modification of diet in renal disease formula. 31 Spot urine data on protein/creatinine levels were not available in these cohorts.…”

Section: Clinical Data and Proteinuriamentioning

confidence: 99%

“…[6][7][8] Proteinuria, in the nephrotic range as well as lowgrade, is associated with renal allograft outcome, but the sensitivity and specificity of proteinuria for graft failure have not been assessed, [9][10][11] unless in a cross-sectional study with a low number of graft failures. 12 Although proteinuria has been related to de novo/recurrent glomerulonephritis or with transplant glomerulopathy, [7][8][9][13][14][15] the association between proteinuria and the strongly evolved diagnostic criteria for allograft pathology, in particular criteria for antibody-mediated rejection, 16,17 has not been considered yet. Current clinical guidelines suggest that a kidney allograft biopsy be performed when there is new onset of proteinuria or unexplained proteinuria $3.0 g/g creatinine or $3.0 g/24 h. However, these international guidelines are not evidence-based (evidence level 2C).…”

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confidence: 99%

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Proteinuria as a Noninvasive Marker for Renal Allograft Histology and Failure

Naesens

Lerut

Emonds

et al. 2016

Journal of the American Society of Nephrology

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Proteinuria is routinely measured to assess renal allograft status, but the diagnostic and prognostic values of this measurement for renal transplant pathology and outcome remain unclear. We included 1518 renal allograft recipients in this prospective, observational cohort study. All renal allograft biopsy samples with concomitant data on 24-hour proteinuria were included in the analyses (n=2274). Patients were followed for $7 years posttransplantation. Compared with proteinuria ,0.3 g/24 h, the hazard ratios for graft failure were 1.14 (95% confidence interval [95% CI], 0.81 to 1.60; P=0.50), for proteinuria 0.3-1.0 g/24 h, 2.17 (95% CI, 1.49 to 3.18; P,0.001), for proteinuria 1.0-3.0 g/24 h, and 3.01 (95% CI, 1.75 to 5.18; P,0.001), for proteinuria .3.0 g/24 h, independent of GFR and allograft histology. The predictive performance of proteinuria for graft failure was lower at 3 months after transplant (area under the receiver-operating characteristic curve [AUC] 0.64, P,0.001) than at 1, 2, and 5 years after transplant (AUC 0.73, 0.71, and 0.77, respectively, all P,0.001). Independent determinants of proteinuria were repeat transplantation, mean arterial pressure, transplant glomerulopathy, microcirculation inflammation, and de novo/recurrent glomerular disease. The discriminatory power of proteinuria for these intragraft injury processes was better in biopsy samples obtained .3 months after transplant (AUC 0.73, P,0.001) than in those obtained earlier (AUC 0.56, P,0.01), with 85% specificity but lower sensitivity (47.8%) for proteinuria .1.0 g/24 h. These data support current clinical guidelines to routinely measure proteinuria after transplant, but illustrate the need for more sensitive biomarkers of allograft injury and prognosis.

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Section: Clinical Data and Proteinuriamentioning

confidence: 99%

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confidence: 99%

Proteinuria as a Noninvasive Marker for Renal Allograft Histology and Failure

Naesens

Lerut

Emonds

et al. 2016

Journal of the American Society of Nephrology

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“…Elevated urine protein excretion, or proteinuria, is indicative of underlying renal pathology and has prognostic significance (1,2). In patients with chronic kidney disease, proteinuria is an independent predictor of progression to kidney failure and death (3).…”

Section: Introductionmentioning

confidence: 99%

Effect of Ramipril on Urinary Protein Excretion in Maintenance Renal Transplant Patients Converted to Sirolimus

Mandelbrot

Alberú

Barama

et al. 2015

American Journal of Transplantation

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This prospective, randomized, double‐blind, placebo‐controlled study evaluated the effects of ramipril on urinary protein excretion in renal transplant patients treated with sirolimus following conversion from a calcineurin inhibitor. Patients received ramipril or placebo for up to 6 weeks before conversion and 52 weeks thereafter. Doses were increased if patients developed proteinuria (urinary protein/creatinine ratio ≥0.5); losartan was given as rescue therapy for persistent proteinuria. The primary end point was time to losartan initiation. Of 295 patients randomized, 264 met the criteria for sirolimus conversion (ramipril, 138; placebo, 126). At 52 weeks, the cumulative rate of losartan initiation was significantly lower with ramipril (6.2%) versus placebo (23.2%) (p < 0.001). No significant differences were observed between ramipril and placebo for change in glomerular filtration rate from baseline (p = 0.148) or in the number of patients with biopsy‐confirmed acute rejection (13 vs. 5, respectively; p = 0.073). One patient in the placebo group died due to cerebrovascular accident. Treatment‐emergent adverse events were consistent with the known safety profile of sirolimus and were not potentiated by ramipril co‐administration. Ramipril was effective in reducing the incidence of proteinuria for up to 1 year following conversion to sirolimus in maintenance renal transplant patients.

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“…Proteinuria can signal pathologic changes including recurrent or de novo glomerular disease, calcineurin inhibitor toxicity, alloantibody-mediated injury and chronic allograft nephropathy [98] . In this way, graft biopsy helps to determine the etiology of proteinuria [20,99] and to manage some treatable causes of graft injury. KDIGO guidelines [20] proposed monitoring of proteinuria as part of routine transplant follow-up.…”

Section: Proteinuriamentioning

confidence: 99%

Estimating glomerular filtration rate in kidney transplantation: Still searching for the best marker

Santos

Martins

2015

WJN

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Kidney transplantation is the treatment of choice for endstage renal disease. The evaluation of graft function is mandatory in the management of renal transplant recipients. Glomerular filtration rate (GFR), is generally considered the best index of graft function and also a predictor of graft and patient survival. However GFR measurement using inulin clearance, the gold standard for its measurement and exogenous markers such as radiolabeled isotopes ( 51 Cr EDTA, 99m

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Posttransplantation Proteinuria

Cited by 55 publications

References 58 publications

Proteinuria as a Noninvasive Marker for Renal Allograft Histology and Failure

Proteinuria as a Noninvasive Marker for Renal Allograft Histology and Failure

Effect of Ramipril on Urinary Protein Excretion in Maintenance Renal Transplant Patients Converted to Sirolimus

Estimating glomerular filtration rate in kidney transplantation: Still searching for the best marker

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