Early low-grade proteinuria: causes, short-term evolution and long-term consequences in renal transplantation.
Proteinuria 1 year after transplantation is associated with poor renal outcome. It is unclear whether low-grade (<1 g/24 h) proteinuria earlier after transplantation and its short-term change affect long-term graft survival. The effects of proteinuria and its change on long-term graft survival were retrospectively assessed in 484 renal transplant recipients. One- and 3-month proteinuria correlated with donor age, donor cardiovascular death, prolonged cold and warm ischemia times and acute rejection. One- and 3-month proteinuria (per 0.1 g/24 h, hazard ratio (HR): 1.07 and 1.15, p<0.0001)-especially low-grade proteinuria (HR: 1.20 and 1.26, p<0.0001)-were powerful, independent predictors of graft loss. Its short-term reduction correlated with arterial pressure (AP) (the lower the 3-month diastolic and 12-month systolic AP, the lower the risk of increasing proteinuria during 1-3 months and 3-12 months periods, respectively: Odds ratio (OR) per 10 MmHg: 0.78, p=0.01 and 0.85, respectively, p=0.02), and was associated with decreased long-term graft loss (per 0.1 g/24 h: HR: 0.88 and 0.98, respectively, p<0.0001), independently of initial proteinuria. Early low-grade proteinuria due to pre-transplant renal lesions, ischemia-reperfusion and immunologic injuries is a potent predictor of graft loss. Short-term reduction in proteinuria is associated with improved long-term graft survival.
Halimi
Jean-Michel
JM
Department of Nephrology and Clinical Immunology, Francois Rabelais University, Tours, France. halimi@med.univ-tours.fr
Laouad
Inass
I
Buchler
Matthias
M
Al-Najjar
Azmi
A
Chatelet
Valérie
V
Houssaini
Tarik Sqalli
TS
Nivet
Hubert
H
Lebranchu
Yvon
Y
D000328:Adult; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000175:diagnosis* / Q000209:etiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors
D007166:Immunosuppressive Agents