Post-transplant nephrotic syndrome: A comprehensive clinicopathologic study.
BACKGROUND
Post-transplant (Tx) nephrotic syndrome (NS) is not well defined.


METHODS
Seventy-four renal transplant recipients with NS were studied.


RESULTS
Biopsies showed chronic allograft nephropathy (CAN) in 31 patients; recurrent glomerular disease (GN) in 15, de novo GN in 18, and undetermined GN in 9. NS developed 0.25 to 384 months post-Tx and was treated with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in 18 patients; calcium channel blockers in 25; or both drugs in 31. NS remitted in 24% of cases 2 to 28 months after onset, and this persisted in all except 3 patients. The remission rate was lowest (9%) for CAN and highest (47%) for de novo GN. Compared with persistent NS, those with remission showed higher prevalence of de novo GN (53% vs. 17%), lower prevalence of CAN (18% vs. 50%), earlier onset of NS (39 vs. 59 months), lower serum SCr at onset (2.3 vs. 2.9 mg/dL), and higher incidence of treatment with ACE or ARB. The 5-year graft loss rates for CAN, recurrent and de novo GN were 57%, 36%, and 23%, respectively. Compared with the functioning grafts, the failed grafts showed higher prevalence of CAN (60% vs. 16%), lower prevalence of de novo GN (12% vs. 46%), earlier onset of NS (47 vs 65 months post-Tx), higher serum SCr at onset (3.3 vs. 2.0 mg/dL), lower prevalence of remission of NS (5% vs. 48%), and higher proteinuria at follow-up (5.1 vs. 2.5 g/day). Graft survival improved with NS remission (88% vs. 18%).


CONCLUSIONS
Post-Tx NS displays distinctive clinicopathologic features with pathogenetic and therapeutic implications.
Yakupoglu
Ulkem
U
Department of Pathology, Renal Section, Baylor College of Medicine, and The Methodist Hospital, The kidney Institute of Houston, Texas 77030, USA.
Baranowska-Daca
Elzbieta
E
Rosen
Daniel
D
Barrios
Roberto
R
Suki
Wadi N
WN
Truong
Luan D
LD
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*; D011507:Proteinuria / Q000209:etiology; D013997:Time Factors