Chronic allograft nephropathy and nephrotic range proteinuria.
While the association between post-transplant nephrotic range proteinuria (PTx-NP) and chronic allograft nephropathy (CAN) has been described, the factors that determine graft survival in such patients are unclear. We retrospectively identified 30 patients with biopsy-proven CAN who presented with PTX-NP between 1988 and 2002. Patients were stratified into two groups according to PTX-NP onset: <1 yr vs. >1 yr post-transplantation. Both groups were comparable with respect to the degree of renal dysfunction (serum creatinine 4.3 +/- 2.5 mg/dL vs. 3.4 +/- 1.5 mg/dL) and proteinuria (4.7 +/- 1.6 gm/d vs. 5.8 +/- 3 gm/d). After a mean follow-up of 14 months post-biopsy, 87% of patients had lost their grafts in both groups (89% vs. 83%, p = NS). Overall, patients with serum creatinine <or=2 mg/dL had better graft survival during follow-up than patients with serum creatinine >2 mg/dL (75% vs. 4%, Fisher Exact Probability p = 0.0038). Using Kaplan-Meier estimate, the 5-yr graft survival rate was 100% for patients with serum creatinine <or=2 mg/dL and 40% in those with >2 mg/dL (p = 0.06). The magnitude of proteinuria beyond 3 gm/d did not influence graft survival. One-half of the patients (n = 15) received therapy with angiotensin converting enzyme inhibitors (ACEI). Graft survival, however, was not different between the patients who received ACEI compared with the patients who did not receive ACEI (13% vs. 13%). PTx-NP related to CAN was associated with poor allograft survival, irrespective of the time of onset of presentation, especially when renal function was reduced at the time of biopsy.
Ramanathan
Venkataraman
V
Renal Section, MED Veterans Affairs Medical Center and O'Brien Kidney Research Center, Baylor College of Medicine, Houston, TX 77030, USA. naliniram@yahoo.com
Suki
Wadi N
WN
Rosen
Daniel
D
Truong
Luan D
LD
D000328:Adult; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000097:blood / Q000209:etiology*; D011507:Proteinuria / Q000097:blood / Q000209:etiology*; D012189:Retrospective Studies
D003404:Creatinine