Proteinuria after conversion to sirolimus in kidney transplant recipients: impact of pre-existing proteinuria, graft function, and angiotensin-converting enzyme inhibitors/angiotensin-receptor antagonists.
BACKGROUND
Proteinuria is a known side effect of therapy with sirolimus. The effect of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEI/ARB ) on sirolimus-associated proteinuria has not yet been assessed.


METHODS
A retrospective cohort study of renal transplant patients treated with sirolimus (n = 55) was performed.


RESULTS
Of 55 patients, 24 (44%) had no proteinuria (<0.15 g/d) prior to conversion. Of 24 patients, 11 (46%) showed de novo proteinuria >0.15 g/d after 12 months, only 2 developed proteinuria > 1 g/d. The total number of proteinuria >1 g/d after 12 months including patients with pre-existing proteinuria >1 g/d (n = 3) was seven of 55 patients (13%). Multivariate regression analysis revealed pre-existing proteinuria > 0.15 g/d and reduced glomerular filtration rate as independent predictors for the development of proteinuria after conversion to sirolimus.


CONCLUSIONS
Reduced glomerular filtration rate and pre-existing proteinuria but not therapy with ACEI/ARB are independent predictors for proteinuria after conversion to sirolimus. Treatment with ACEI/ARB did not reduce pre-existing proteinuria after conversion except in single cases with severe proteinuria.
Marx
Christian
C
Klinik für Innere Medizin III, Klinikum der Friedrich-Schiller-Universität, Jena, Germany.
Busch
Martin
M
Ott
Undine
U
Gerth
Jens
J
Wolf
Gunter
G
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007668:Kidney / Q000502:physiology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000139:chemically induced* / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D020123:Sirolimus / Q000009:adverse effects* / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D007166:Immunosuppressive Agents; D020123:Sirolimus