Proteinuria following renal transplantation: Correlation with histopathology and outcome

Peddi, V. Ram; Dean, D; Hariharan, Sundaram; Cavallo, T; Schroeder, T. J.; First, M. Roy

doi:10.1016/s0041-1345(96)00022-x

Cited by 53 publications

(48 citation statements)

References 5 publications

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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%

“…Chronic rejection (formerly referred to as CAN) has been also shown to be a risk factor in most adult studies [5][6][7]9]. However, one study based on biopsy findings showed a similar proportion of CAN in proteinuric and nonproteinuric adult patients [11].…”

Section: Rejectionmentioning

confidence: 99%

“…Many studies have investigated the histopathological characteristics in patients with proteinuria after RTx [5,7,9,11,21,26]. Transplant glomerulopathy with glomerulonephritis (recurrent or de novo) and chronic vascular rejection are the most common histological findings.…”

Section: Histopathological Findings In Transplanted Patients With Promentioning

confidence: 99%

“…Transplant patients with proteinuria show shorter graft survival than those without proteinuria [4,[6][7][8][9][10][11][12] (Table 3; Fig. 5).…”

Section: Consequences To Renal Allograftmentioning

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: 99%

Section: Rejectionmentioning

confidence: 99%

Section: Histopathological Findings In Transplanted Patients With Promentioning

confidence: 99%

“…Transplant patients with proteinuria show shorter graft survival than those without proteinuria [4,[6][7][8][9][10][11][12] (Table 3; Fig. 5).…”

Section: Consequences To Renal Allograftmentioning

confidence: 99%

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Management of proteinuria in the transplanted patient

Seeman

2014

Pediatr Nephrol

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“…19 Proteinuria has been reported in up to 30% of RTRs. 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.…”

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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