Prognostic Significance of Creeping Proteinuria in the First Year After Transplantation

Calabuig, Asunción Sancho; Martínez, Eva Gavela; Berga, J. Kanter; Catalán, Sandra Beltrán; Bernabeu, Ana Isabel Avila; Mateu, L.M. Pallardó

doi:10.1097/tp.0000000000000775

Cited by 7 publications

(6 citation statements)

References 36 publications

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“…We tested variables that could influence graft survival and found 9 traditional risk factors to have statistically significant associations with the primary outcome of graft failure. However, unlike previous studies, we did not find recipient obesity and DGF to be associated with the outcome .…”

Section: Discussionmentioning

confidence: 99%

Kidney allograft failure in the steroid‐free immunosuppression era: A matched case‐control study

Alkadi

Kim

Aull

et al. 2017

Clinical Transplantation

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We studied the causes and predictors of death-censored kidney allograft failure among 1670 kidney recipients transplanted at our center in the corticosteroid-free maintenance immunosuppression era. As of January 1, 2012, we identified 137 recipients with allograft failure; 130 of them (cases) were matched 1-1 for recipient age, calendar year of transplant, and donor type with 130 recipients with functioning grafts (controls). Median time to allograft failure was 29 months (interquartile range: 18-51). Physician-validated and biopsy-confirmed categories of allograft failure were as follows: acute rejection (21%), glomerular disease (19%), transplant glomerulopathy (13%), interstitial fibrosis tubular atrophy (10%), and polyomavirus-associated nephropathy (7%). Graft failures were attributed to medical conditions in 21% and remained unresolved in 9%. Donor race, donor age, human leukocyte antigen mismatches, serum creatinine, urinary protein, acute cellular rejection, acute antibody-mediated rejection, BK viremia, and CMV viremia were associated with allograft failure. Independent predictors of allograft failure were acute cellular rejection (odds ratio: 18.31, 95% confidence interval: 5.28-63.45) and urine protein ≥1 g/d within the first year post-transplantation (5.85, 2.37-14.45). Serum creatinine ≤1.5 mg/dL within the first year post-transplantation reduced the odds (0.29, 0.13-0.64) of allograft failure. Our study has identified modifiable risk factors to reduce the burden of allograft failure.

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Section: Discussionmentioning

confidence: 99%

Kidney allograft failure in the steroid‐free immunosuppression era: A matched case‐control study

Alkadi

Kim

Aull

et al. 2017

Clinical Transplantation

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“… 23 - 25 For renal transplant patients, proteinuria is the most common indicator of kidney injury, and is an independent risk factor for reduced graft and patient survival, 23 , 24 especially when creeping persistent proteinuria is present. 26 Possible reasons for posttransplant proteinuria include glomerulonephritis, chronic or acute rejection, chronic transplant glomerulopathy, and cyclosporine nephrotoxicity. 27 …”

Section: Discussionmentioning

confidence: 99%

Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys

et al. 2019

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Background. Reports about prognosis of adults receiving small pediatric-donor kidneys (PDK) as compared to those receiving elder pediatric or adult donor kidneys (ADKs) are controversial. This study aimed to examine the outcomes of adults receiving small PDK and possible prognostic factors. Methods. The records of adults who received kidneys from donors < 10 years old at our center from July 1, 2011 to June 30, 2018 were reviewed. Results. A total of 121 adults were small PDK recipients. Twenty-three patients received 29 biopsies or nephrectomy between 6 and 896 days posttransplantation days. Seven patients (30.4%) had pediatric donor glomerulopathy (PDG), which developed from 113 to 615 days posttransplantation. The incidence of proteinuria and hematuria was significantly higher in the PDG group. The characteristic pathological finding in PDG was irregular lamination and splintering of the glomerular basement membrane (GBM). Donor age, donor weight, and donor kidney volume were significantly less in PDG cases compared with the non-PDG cases. For the risk factors of PDG, increasing urinary RBC count during follow-up was an independent predictor, while increasing donor age and body weight were protective factors. PDG was not a significant risk factor for Scr increasing of PDKs. Conclusions. PDG is a potential cause of abnormal urinalysis in adults receiving small PDKs. The pathological characteristic change of PDG is splitting and lamination of GBM. Persistent hematuria after transplantation in recipients of PDK is a predictor of PDG development.

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“…Post-transplanted proteinuria could be originated from several causes including factors related to graft lesions during transplant procedure, such as long cold ischemia time; factors related to the recovery of graft function, such as delayed graft function, acute rejection episodes, and effect of mammalian target of rapamycin inhibitor drugs; factors related to functional discrepancy between the donors and recipients; and factors related to donor characteristics, such as age and cardiovascular diseases [ 12 , 14 , 18 , 19 ]. Halimi et al have observed that early low-grade proteinuria (as early as 1 month after transplantation) was associated with donor age, cardiovascular cause of donor death, prolonged cold and warm ischemia times, and acute rejection episodes [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Proteinuria from native kidneys commonly occurs when renal transplants are performed in patients who have considerable residual urine output pre-transplant or diabetes and usually decreases after a successful transplant [ 14 ]. To avoid the interference factors of proteinuria from native kidneys, we particularly studied the population except for diabetes or donors with proteinuria pre-operative and there was no significant difference of pre-urine output between Group A and Group B.…”

Section: Discussionmentioning

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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Prognostic Significance of Creeping Proteinuria in the First Year After Transplantation

Cited by 7 publications

References 36 publications

Kidney allograft failure in the steroid‐free immunosuppression era: A matched case‐control study

Kidney allograft failure in the steroid‐free immunosuppression era: A matched case‐control study

Pediatric Donor Glomerulopathy Is a Possible Cause of Abnormal Urinalysis in Adults Receiving Small Pediatric Donor Kidneys

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

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