Proteinuria After Renal Transplantation Affects Not Only Graft Survival but Also Patient Survival

Roodnat, Joke I.; Mulder, Paul; Rischen-Vos, J.; Riemsdijk, I. C. van; Gelder, Teun van; Zietse, Robert; IJzermans, Jan N.M.; Weimar, Willem

doi:10.1097/00007890-200108150-00014

Cited by 190 publications

(132 citation statements)

References 42 publications

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“…In studies involving adult populations which used a very liberal threshold of 2-3 g/day, prevalence was only 10-15 % [5,7]. In contrast, studies that used a threshold similar to that used for non-transplanted patients (0.15-0.25 g/day) revealed proteinuria in 31-45 % of patients [4,11].…”

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

confidence: 95%

“…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 recent years there has been an increasing interest in the role of proteinuria also in patients after renal transplantation, as it has been demonstrated that it is an important and potentially treatable risk factor for graft loss and patient mortality [4].…”

Section: Introductionmentioning

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

confidence: 95%

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

confidence: 99%

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Management of proteinuria in the transplanted patient

Seeman

2014

Pediatr Nephrol

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“…In addition, the subgroup analysis of the kidney biopsies showing significantly more lesions of segmental or global glomerulosclerosis in the group with low KwRw ratio suggests that glomerular protein leakage resulting from overfiltration of transplants performed within the context of small KwRw ratios could lead to chronic inflammation, interstitial fibrosis and glomerulosclerosis, 1,35,36 and finally to a decrease in graft function and graft loss. [37][38][39] Given that interstitial fibrosis and chronic graft inflammation can be generated by both immunologic and nonimmunologic parameters, we focused exclusively on glomerulosclerosis in our study, even though we are aware that glomerulosclerosis 40 is not specific to glomerular hyperfiltration.…”

Section: Discussionmentioning

confidence: 99%

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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“…20 In renal transplantation, proteinuria at 1 year is coupled with a double-fold risk of CV death. 21 Persistent proteinuria can predict succeeding IHD and PVOD. 22 Low grade proteinuria discovered at early phase of post renal transplantation, is coupled with inferior graft and patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Role of homocysteine level as risk factor in the occurrence of cardiovascular events in renal transplant recipients

Goswami¹,

Sepaha

Dube³

et al. 2018

Int J Clin Trials

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Background: Traditional risk factors like elevated homocysteine levels may not completely explain the higher CVD seen in RTRs. Identification and optimisation of modifiable risk factors may help to reduce the occurrence of CVD in such population. To study the role of homocysteine level as risk factor in the occurrence of cardiovascular events in renal transplant patients. Another objective was to evaluate the other risk factors in the occurrence of CVD in such population.Methods: Thirty renal transplant recipients and thirty healthy controls were studied. Inclusion criteria were transplant duration >6 months and patients with chronic stable renal function over the last 3 months. Samples for fasting plasma homocysteine were collected and plasma homocysteine was then estimated. All the patients were followed up every month for 6 months and evaluated for occurrence of any cardiovascular event.Results: The mean hornocysteine levels were found to be 27.4±7.902 µmol/L in cases and 10.86±1.98 µmol/L in controls. There was no statistically significant relationship between homocysteine levels and transplant duration, mean IMT levels, proteinuria, and presence of left ventricular hypertrophy or choice of immunosuppressive regimen. Of the 30 patients, 6 patients (20%) had evidence of cardiovascular event. In the absence of other conventional factors, age of the patient, creatinine clearance (index of graft function) and mean intima-media thickness were more closely related with cardiovascular events. Conclusions: Plasma homocysteine failed to show as an independent risk factor for cardiovascular events. New, emerging cardiovascular risk factors (e.g. Lipoprotein (a), high sensitivity C-reactive protein, fibrinogen, tissue plasminogen activator and plasminogen activator inhibitor-1) should be studied to design effective therapy to delay the progression of atherosclerosis and prolong the life of renal transplant recipients.

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Proteinuria After Renal Transplantation Affects Not Only Graft Survival but Also Patient Survival

Abstract: Proteinuria after renal transplantation increases both the risk for graft failure and the risk for death.

Cited by 190 publications

References 42 publications

Management of proteinuria in the transplanted patient

Management of proteinuria in the transplanted patient

Kidney and Recipient Weight Incompatibility Reduces Long-Term Graft Survival

Role of homocysteine level as risk factor in the occurrence of cardiovascular events in renal transplant recipients

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