title: Conversion from calcineurin inhibitors to sirolimus in chronic allograft dysfunction: changes in glomerular haemodynamics and proteinuria.
abstract: BACKGROUND
  The study was conducted in order to describe possible intraglomerular haemodynamic changes inducing proteinuria after 14 patients with chronic allograft dysfunction were converted from calcineurin inhibitors (CIs) to sirolimus without changing concomitant immunosuppression or antihypertensive treatment.
  
  
  METHODS
  Creatinine, glomerular filtration rate (GFR), proteinuria, renal functional reserve (RFR) and effective renal plasma flow (ERPF) were determined before and 8 months after conversion. Intraglomerular pressure (P(G)), afferent arteriolar resistance (AAR) and efferent arteriolar resistance (EAR) were calculated using Gomez's formula.
  
  
  RESULTS
  Creatinine (1.97 vs 2.075 mg/dl; P = 0.270) and GFR (40 vs 43 ml/min; P = 0.505) remained unchanged, proteinuria increased (338 vs 1146 mg/24 h; P = 0.006), RFR decreased (34.84 vs 13.47%; P = 0.019), ERPF (248 vs 310.6 ml/min; P = 0.0625) and P(G) (42.72 vs 46.17 mmHg; P = 0.0625) tendentially increased and AAR tendentially decreased (14.12 vs 10.28 dyne/s/cm(5); P = 0.0625).
  
  
  CONCLUSIONS
  After conversion, P(G) shows a tendency to increase and RFR decreases significantly-characteristics of hyperfiltration, which could possibly partially explain the increase of proteinuria. Therefore, the application of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers seems promising. To avoid hyperfiltration, conversion should be performed early when renal insufficiency is still moderate.
authors.affiliation: Nephrology Department, Hospital de Terrassa, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Saurina
authors.forename: Josep M
authors.initials: JM
authors.lastname: Campistol
authors.forename: Carlos
authors.initials: C
authors.lastname: Piera
authors.forename: Fritz
authors.initials: F
authors.lastname: Diekmann
authors.forename: Begoña
authors.initials: B
authors.lastname: Campos
authors.forename: Nieves
authors.initials: N
authors.lastname: Campos
authors.forename: Xavier
authors.initials: X
authors.lastname: de las Cuevas
authors.forename: Federico
authors.initials: F
authors.lastname: Oppenheimer
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D002908:Chronic Disease; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy*; D007678:Kidney Glomerulus / Q000187:drug effects* / Q000503:physiopathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D011507:Proteinuria / Q000139:chemically induced* / Q000503:physiopathology*; D020123:Sirolimus / Q000627:therapeutic use*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus