Analysis of allograft biopsy specimens in renal transplants with proteinuria: is proteinuria a culprit of graft loss?
It has been proposed that proteinuria occurring after renal transplantation may be not only a marker but also a culprit of allograft dysfunction. We retrospectively analyzed the data from 55 patients who underwent transplant renal biopsy for proteinuria and/or azotemia occurring beyond 1 year after transplantation. Proteinuria was considered as significant when > or = 30 mg/dL, and the results of transplant biopsy were categorized according to the Banff 97 classification. Logistic regression was used to estimate odds ratios (OR) for graft loss associated with proteinuria and transplant pathology. The patients were followed for 86.0 +/- 32.8 months after transplantation, and transplant biopsy was performed at 54.1 +/- 31.0 months. Proteinuria at 1 year after transplantation noted in 29.1% of patients was not significantly associated with graft loss (OR = 1.94, 95% CI from 0.59 to 6.41). In addition, proteinuria at the time of transplant biopsy was not significantly associated with graft loss. Chronic allograft nephropathy was the most frequent transplant pathology. Only glomerulonephritis was significantly associated with proteinuria at the time of the transplant biopsy. On the other hand, graft loss was significantly associated with the presence of proteinuria both at 1 year after transplant biopsy and at the final follow-up. These results suggest that posttransplantation proteinuria is an important marker of graft dysfunction, but is not predictive of graft loss in biopsy-proven cases. Appropriate management guided by the results of a transplant biopsy may improve the outcome.
Kang
C M
CM
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea. kangjm@hanyang.ac.kr
Kim
G-H
GH
Lee
C H
CH
Kwak
J Y
JY
Kwon
O J
OJ
D001706:Biopsy; D006085:Graft Survival; D016030:Kidney Transplantation / Q000401:mortality / Q000473:pathology* / Q000502:physiology; D011507:Proteinuria; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous / Q000473:pathology / Q000502:physiology; D017211:Treatment Failure