Proteinúria after kidney transplantation - prevalence and risk factors

Oliveira, Cláudia Maria Costa de; Pereira, Izadora de S.; Souza, Larissa Clara L. de; Cruz, Thiago A.; Júnior, Francisco Marto Leal Pinheiro; Esmeraldo, Ronaldo M.

doi:10.5935/0101-2800.20150076

Cited by 4 publications

(10 citation statements)

References 39 publications

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“…However, RAS inhibitors have potentially irreplaceable clinical significance because of their ability to improve outcomes. Many studies have investigated the possible benefits of ACEI/ARB treatment for renal transplant recipients, including the roles of controlling hypertension, reducing proteinuria and managing cardiovascular disease [1,10,11,52]. Despite this, and despite prescriptions for RAS inhibitors increasing from <20% in the early 1990s to >45% in the 2000s [19,53], there is no consensus on the benefits they offer for either patient or graft survival.…”

Section: Discussionmentioning

confidence: 99%

“…Concerning kidney transplant recipients, previous studies have confirmed that ACEI/ARB treatment is beneficial for hypertension and proteinuria [10,11], both of which are risk factors for patient death and graft loss [12]. ACEI/ARB treatment can also reduce the risk of cardiovascular events, which is the major cause of death in kidney recipients [13].…”

Section: Introductionmentioning

confidence: 97%

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Effect of renin‐angiotensin system inhibitors on survival in kidney transplant recipients: A systematic review and meta‐analysis

Jiang

Song

Qiu

et al. 2017

The Kaohsiung J of Med Scie

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Renin-angiotensin system inhibitors, specifically angiotensin II converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB), have confirmed renoprotective benefits in patients with proteinuria and hypertension. However, it remains controversial whether these agents are beneficial to kidney recipients. We conducted this meta-analysis to evaluate the effects of ACEI/ARB treatment on patient and allograft survival after kidney transplant. The PubMed, Embase and Cochrane Library databases were searched for eligible articles from before May 2016, and we included 24 articles (9 randomised controlled trials [RCTs] and 15 cohort studies with 54,096 patients), in which patient or graft survival was compared between an ACEI/ARB treatment arm and a control arm. Pooled results showed that ACEI/ARB was associated with decreased risks of patient death (relative risk [RR] = 0.64; 95% confidence interval [CI]:0.49-0.84) and graft loss (RR = 0.59; 95%CI:0.47-0.74). Subgroup analysis of the cohorts revealed significantly reduced patient death (RR = 0.61; 95%CI:0.50-0.74) and graft loss (RR = 0.58; 95%CI:0.46-0.73), but this was not seen in RCTs (patient survival: RR = 0.84, 95%CI:0.39-1.81; graft survival: RR = 0.70, 95%CI:0.17-2.79). Significantly less graft loss was noted among patients with biopsy-proved chronic allograft nephropathy (CAN) (RR = 0.26, 95%CI:0.16-0.44). Furthermore, the benefit of ACEI/ARB on patient survival (RR = 0.62; 95%CI:0.47-0.83) and graft survival (RR = 0.58, 95%CI:0.47-0.71) was limited to those with ≥3years' follow-up. ACEI/ARB decreased proteinuria (P < 0.001) and lowered haemoglobin (P = 0.002), but the haemoglobin change requires no additional treatment (from 119-131 g/L to 107-123 g/L). We therefore concluded that ACEI/ARB treatment may reduce patient death and graft loss, but additional well-designed prospective studies are needed to validate these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Effect of renin‐angiotensin system inhibitors on survival in kidney transplant recipients: A systematic review and meta‐analysis

Jiang

Song

Qiu

et al. 2017

The Kaohsiung J of Med Scie

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“…Proteinuria soon after KT can already be identified, however, it tends to reduce or disappear after a few days. This condition, when persistent for more than 3 months post-KT, carries risks for the progression and failure of the allograft 35 .…”

Section: H Proteinuria ≥ 300 Mgmentioning

confidence: 99%

“…The causes of pt24h post-KT are diverse, and other risk factors may contribute to its development, such as post-KT SAH, age, number of episodes of acute rejection and NODAT 35 . Indirectly, these covariates affect allograft survival and should be considered before and after KT.…”

Section: H Proteinuria ≥ 300 Mgmentioning

confidence: 99%

Modelagem das covariáveis preditivas para falência do enxerto renal até seis meses do transplante

et al. 2022

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Introdução: Transplante renal (TR) é a terapia renal substitutiva (TRS) de escolha para pacientes com doença renal crônica (DRC). Entretanto, nem todo TR é bem-sucedido e alguns pacientes persistem em TRS. Objetivo: Modelar uma regressão logística com covariáveis de risco pré e pós-TR preditora da disfunção secundária do aloenxerto com necessidade de TRS ou alcance ao estágio V da DRC até os primeiros seis meses pós-TR. Métodos: Coorte com receptores transplantados realizado em hospital no Nordeste brasileiro. Analisou-se registros médicos dos TR realizados entre 2011-2018. Receptores com dados insuficientes ou que abandonaram seguimento foram excluídos. Foram analisadas covariáveis: demográficas; infecciosas; comorbidades pré e pós-TR; painel de reatividade; incompatibilidades de HLA; episódios de rejeições agudas mediadas por células-T ou por anticorpos; exames laboratoriais seis meses pós-TR. Resultados: Receptores idosos (OR:1,41; IC95%:1,01-1,99), tempo entre início da TRS e TR (∆T-TRS&TR)>10 anos (OR:3,54; IC95%:1,27-9,87), diabetes mellitus (DM) pré-TR (OR:3,35; IC95%:1,51-7,46), pielonefrite (OR:2,45; IC95%:1,24-4,84), nefropatia por poliomavírus (OR:4,99; IC95%:1,87-13,3), RAMA (OR:4,82; IC95%:1,35-17,2), proteinúria de 24h (Pt24h) ≥300mg/24h (OR:5,05; IC95%:2,00-12,7) e cálcio sérico (Ca)<8,5mg/dL (OR:4,72; IC95%:2,00-11,1) foram identificadas como covariáveis de maior risco para os desfechos analisados até seis meses pós-TR. O modelo multivariado apresentou acurácia de 88,1% e fator de inflação da variância médio de 1,81. Conclusão: Receptores idosos, ∆T-TRS&TR>10anos, DM pré-TR e agressões até seis meses pós-TR (pielonefrite, nefropatia por poliomavírus, RAMA, Pt24h≥300mg/24h e Ca<8,5mg/dL), apresentam alto poder preditivo para disfunção secundária do aloenxerto com necessidade de TRS ou alcance ao estágio V da DRC até os primeiros seis meses pós-TR.

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“…As we all know, proteinuria is a biological marker of renal abnormality and an important risk factor of progressive renal damage and subsequent renal function decline in most nephropathies [ 1 – 3 ]. In addition, proteinuria after renal transplantation has been associated with poor implant outcome for years [ 4 – 9 ]. Early proteinuria (persistence of urine protein excretion >0.5-1.0 g/24h during one- and three-month) is an independent powerful predictor of graft loss, cardiovascular morbidity and mortality, and short-term reduction of proteinuria is associated with improved long-term graft survival [ 2 , 10 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of earlier-proteinuria on graft functions after one-year living donor renal transplantation

Dai

Chen

et al. 2017

Oncotarget

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BackgroundProteinuria is an indicator of subsequent renal function decline in most nephropathies and early proteinuria has been assumed to be a risk factor of poor kidney transplant outcomes. However, there is no information about the effect of earlier-proteinuria at the first week on short-term graft function after living donor renal transplantation.MethodsRetrospective cohort study of 439 living donor kidney transplants to analyze the effect of early proteinuria at 7-day post-transplantation on short-term prognosis of living donor renal transplantation. Patients were stratified into 2 groups according to the definition of earlier-proteinuria: Group A as proteinuria < 0.4 g/24h and Group B as proteinuria ≥ 0.4 g/24h, and differences over the first year post-transplantation were analyzed.ResultsPatients with earlier-proteinuria ≥ 0.4 g/24h had a significantly higher 1-year proteinuria and lower 1-year graft function post-transplantation. Discrepancies of weight ratio of donor-recipient and mean artery pressure difference of recipient to donor influenced the urine protein excretion at the 7-day post-transplantation.ConclusionsEarlier-proteinuria at 7-day after living donor renal transplantation was associated with short-term graft function. To eliminate the functional discrepancies between living donors and recipients could be viewed as a solution of reducing earlier-proteinuria.

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Proteinúria after kidney transplantation - prevalence and risk factors

Cited by 4 publications

References 39 publications

Effect of renin‐angiotensin system inhibitors on survival in kidney transplant recipients: A systematic review and meta‐analysis

Effect of renin‐angiotensin system inhibitors on survival in kidney transplant recipients: A systematic review and meta‐analysis

Modelagem das covariáveis preditivas para falência do enxerto renal até seis meses do transplante

Effect of earlier-proteinuria on graft functions after one-year living donor renal transplantation

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