Nephrotic Range Proteinuria in Renal Transplantation: Clinical and Histologic Correlates in a 10-year Retrospective Study

Leal, Rita; Pinto, Helena; Galvão, Ana; Santos, Lídia; Romãozinho, Catarina; Macário, Fernando; Alves, Rui; Pratas, Jorge; Sousa, Vítor; Marinho, Carol; Castro, Lígia; Campos, Mário; Mota, A.; Figueiredo, Arnaldo

doi:10.1016/j.transproceed.2017.01.066

Cited by 6 publications

(13 citation statements)

References 9 publications

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“…The prevalence of nephrotic proteinuria (NP) after a kidney transplant in our series was 18.6%, which fell within the range of 11-22% described in previous studies [11,12,15,16]. Nephrotic syndrome (NS) appeared in 12.6% of our transplant recipients, a rate that is similar to that reported by Yakupoglu et al in their 2004 series [15] but higher than those of previous reports [18].…”

Section: Discussionsupporting

confidence: 86%

“…There is little information regarding the appearance of nephrotic syndrome in transplant recipients. Few articles can be found [15,16], and they are either quite old [11][12][13]17,18], are single cases [19], or refer exclusively to children [20]. In the experience of our transplant group, nephrotic-range proteinuria after a kidney transplant, defined as >3000 mg/24 h, appears more often as an isolated finding and exceptionally in complete nephrotic syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Consequences of Nephrotic Proteinuria and Nephrotic Syndrome after Kidney Transplant

Ortega,

Martínez-Belotto,

García-Majado

et al. 2024

Biomedicines

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Proteinuria is the main predictor of kidney graft loss. However, there is little information regarding the consequences of nephrotic proteinuria (NP) and nephrotic syndrome (NS) after a kidney transplant. We aimed to describe the clinical and histopathological characteristics of kidney recipients with nephrotic-range proteinuria and compare the graft surveillance between those who developed NS and those who did not. A total of 204 patients (18.6% of kidney transplants in the study period) developed NP, and 68.1% of them had NS. Of the 110 patients who underwent a graft biopsy, 47.3% exhibited ABMR, 21.8% the recurrence of glomerulonephritis, 9.1% IFTA, and 7.3% de novo glomerulonephritis. After a median follow-up of 97.5 months, 64.1% experienced graft loss. The graft survival after the onset of NP declined from 75.8% at 12 months to 38% at 5 years, without significant differences between those with and those without NS. Patients who developed NS fewer than 3 months after the onset of NP exhibited a significantly higher risk of death-censored graft loss (HR: 1.711, 95% CI: 1.147–2.553) than those without NS or those with late NS. In conclusion, NP and NS are frequent conditions after a kidney transplant, and they imply extremely poor graft outcomes. The time from the onset of NP to the development of NS is related to graft survival.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Consequences of Nephrotic Proteinuria and Nephrotic Syndrome after Kidney Transplant

Ortega,

Martínez-Belotto,

García-Majado

et al. 2024

Biomedicines

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“…Thus, his risk of graft loss was substantial prompting us to proceed with ofatumumab infusions. 21 Due to his history of atopy, we started with a low dose of ofatumumab but did not observe remission in our patient. Although the serum albumin had improved to 3 g/dL after receiving a combination therapy of plasmapheresis, rituximab, and CsA, his UPC ratio remained in the nephrotic range (5.7 g/g).…”

Section: Discussionmentioning

confidence: 69%

“…Although our patient, with a genetic mutation of unknown significance, had improvement with established treatments for recurrence of FSGS, his proteinuria remained in nephrotic range. Thus, his risk of graft loss was substantial prompting us to proceed with ofatumumab infusions . Due to his history of atopy, we started with a low dose of ofatumumab but did not observe remission in our patient.…”

Section: Discussionmentioning

confidence: 83%

Ofatumumab in post‐transplantation recurrence of focal segmental glomerulosclerosis in a child

Solomon

Zolotnitskaya

Río

2019

Pediatric Transplantation

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FSGS is a potentially devastating form of nephrotic syndrome. Treatment of SRNS can be difficult, especially post‐transplantation. The current therapy of post‐transplant SRNS includes plasmapheresis, ACE‐I, CNI, and monoclonal antibodies (rituximab). Patients who are refractory to these interventions have limited therapeutic alternatives. We present a case of a patient with SRNS secondary to FSGS. He did not respond to immunosuppressive medications prior to transplant, progressed to ESRD, and was started on chronic hemodialysis. He received a DDKT which was complicated by post‐transplant FSGS recurrence. A course of plasmapheresis, rituximab, and CNI were administered with some response. Ofatumumab was then given to the patient. As a result, the patient achieved partial remission. Ofatumumab may be a safe and effective option for post‐transplant recurrence of FSGS.

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“…At the same time, we propose that ICG-NOS is not necessarily clinically silent or an epiphenomenon of rejection, as 12 (43%) patients in our cohort lacked any evidence of concurrent rejection, of whom 5 had a clinically indicated biopsy for investigation of hematuria, proteinuria, or elevated creatinine that was likely attributable to the ICG-NOS. 15,16 We also explored infection as a potential cause of ICG-NOS. In our cohort, 6 patients (21%) had known infection at the time of biopsy, and 9 patients (32%) had a history of viral activation.…”

Section: Discussionmentioning

confidence: 99%

Histologic Case Definition of an Atypical Glomerular Immune-Complex Deposition Following Kidney Transplantation

Chin

Charu

O’Shaughnessy

et al. 2020

Kidney International Reports

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Introduction: Immune-complex deposition in the transplanted kidney can present as well-phenotyped recurrent or de novo glomerular disease. However, a subset, herein termed immune-complex glomerulopathy not otherwise specified (ICG-NOS), defies classification. We quantified, categorized, and characterized cases of transplant ICG-NOS occurring at a single US academic medical center. Methods: We retrospectively reviewed our single-institution pathology database (July 2007-July 2018) to identify and categorize all cases of immune-complex deposition in kidney allografts (based on immunofluorescence microscopy). We extracted clinicopathologic and outcome data for ICG-NOS (i.e., immune complex deposition not conforming to any well-characterized glomerular disease entity). Results: Of 104 patients with significant immune deposits, 28 (27%) were classified as ICG-NOS. We created 5 mutually exclusive ICG-NOS categories: Full-house, Quasi-full-house, IgA-rich, C1q-rich, and C1q-poor. Overall, 16 (57%) patients met criteria for definite or possible allograft rejection, including 9 (32%) with antibody-mediated rejection (ABMR), 3 (11%) suspicious for ABMR, 1 (4%) with T-cell-mediated rejection (TCMR), and 9 (32%) with borderline TCMR. After a median follow-up of 2.3 (range, 0.1-14.0) years after biopsy, 7 (25%) allografts had failed and an additional 8 (29%) had persistent renal dysfunction (hematuria, 14%; proteinuria, 21%; and estimated glomerular filtration rate <60 ml/min per 1.73 m 2 , 11%). Conclusion: In contrast to prior studies, our findings suggest that ICG-NOS is not necessarily a benign glomerular process and that there may be an association between ICG-NOS and alloimmunity. Our immunofluorescence-based classification provides a framework for future studies aiming to further elucidate ICG-NOS pathogenesis and prognosis.

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Nephrotic Range Proteinuria in Renal Transplantation: Clinical and Histologic Correlates in a 10-year Retrospective Study

Abstract: The main causes of nephrotic range proteinuria in patients undergoing biopsy were transplant glomerulopathy, recurrence of the underlying disease, and de novo glomerulonephritis. Nephrotic range proteinuria was related to a high rate of graft loss.

Cited by 6 publications

References 9 publications

Consequences of Nephrotic Proteinuria and Nephrotic Syndrome after Kidney Transplant

Consequences of Nephrotic Proteinuria and Nephrotic Syndrome after Kidney Transplant

Ofatumumab in post‐transplantation recurrence of focal segmental glomerulosclerosis in a child

Histologic Case Definition of an Atypical Glomerular Immune-Complex Deposition Following Kidney Transplantation

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