Proteinuria in Cyclosporine-Treated Renal Transplant Recipients

Vathsala, A.; Verani, Regina; Schoenberg, L.; Lewis, Richard M.; Buren, Charles T. Van; Kerman, Ronald H.; Kahan, Barry D.

doi:10.1097/00007890-199001000-00008

Cited by 62 publications

(61 citation statements)

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“…The main reason for this wide variation in prevalence of proteinuria is the different threshold used in these studies to define proteinuria. 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 adult studies, the degree (quantity) of proteinuria has been found to be associated with allograft glomerular pathology, as biopsy-proven glomerular disease (e.g. transplant glomerulopathy) has been found to be more prevalent in patients with nephrotic-range proteinuria (66-80 %) than in those with non-nephrotic proteinuria (only 12 % glomerular lesions) [7,11,23,26]. The association between the degree of proteinuria and histological pathology is depicted in Fig.…”

Section: Types Of Post-transplant Proteinuriamentioning

confidence: 99%

“…In a pediatric study by Chua et al, 100 % of children had proteinuria at 1 week after RTx; however, it disappeared in 70 % of patients at 8-9 weeks posttransplant [16]. Such transient proteinuria does not have negative impact on long-term graft survival [6][7][8]20]. To the contrary, later onset proteinuria (>2-3 months posttransplant) or persistent proteinuria (duration >3 months) does have a negative impact on long-term graft survival (see below section Clinical consequences).…”

Section: Types Of Post-transplant Proteinuriamentioning

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%

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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%

Section: Types Of Post-transplant Proteinuriamentioning

confidence: 99%

Section: Types Of Post-transplant Proteinuriamentioning

confidence: 99%

Section: Rejectionmentioning

confidence: 99%

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Management of proteinuria in the transplanted patient

Seeman

2014

Pediatr Nephrol

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Post-transplant Proteinuria: Differential Diagnosis and Management

Akbari

Knoll

2014

Kidney Transplantation

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Effect of enalapril on proteinuria after kidney transplantation

et al. 1993

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We studied the effect of enalapril, an inhibitor of angiotensin-converting enzyme (iACE), on proteinuria and renal function in recipients of renal allografts. Twenty-two patients with post-transplant nephrotic syndrome were treated with incremental doses of enalapril for 1 year. Urinary protein excretion decreased after 2 months of treatment from a mean of 8.9 g/day (range 4.0-18.9 g/day) to 4.5 g/day (range 0.4-10.0 g/day; P < 0.01) and remained significantly low for the rest of the study. However, in the same period, creatinine clearance did not change significantly; it went from 47.8 ml/min (range 17.1-110.3 ml/min) before treatment to 44.2 ml/min (range 16.5-88.5 ml/min) after 2 months of iACE therapy. Analysis of individual data showed that there was a significant reduction in proteinuria in 14 of the 22 patients and that the rate of deterioration of renal function did not increase in 17 of the 22 patients. We did not observe any serious side effects of enalapril administration. The results of our study prove that iACE can be used safely and effectively to reduce post-transplant proteinuria.

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Proteinuria in Cyclosporine-Treated Renal Transplant Recipients

Cited by 62 publications

References 0 publications

Management of proteinuria in the transplanted patient

Management of proteinuria in the transplanted patient

Post-transplant Proteinuria: Differential Diagnosis and Management

Effect of enalapril on proteinuria after kidney transplantation

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