title: Clinical predictors of proteinuria after conversion to sirolimus in kidney transplant recipients.
abstract: Proteinuria is an increasingly recognized effect of sirolimus (SRL) therapy in kidney transplant recipients. Predictors of proteinuria after conversion to SRL are not well described, and in particular the risk in African-American (AA) kidney recipients is unknown. We sought to analyze risk factors for proteinuria with SRL therapy in a cohort of 39 patients (44% AA) converted from tacrolimus to SRL at a mean time of 4 months posttransplantation. Patients were maintained on therapy with mycophenolate mofetil while most patients underwent early steroid withdrawal. Urinary protein to creatinine ratio (Up/cr) at a mean of 14 months postconversion increased to > or =500 mg/g in 65% of AAs versus 14% of non-AAs (p = 0.001). Mean arterial blood pressure at the time of conversion and pretransplant proteinuric kidney disease were also predictors of proteinuria after SRL conversion. In conclusion, AAs appear to be at high risk for proteinuria and should be monitored closely after conversion to SRL in calcineurin inhibitor sparing protocols.
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Padiyar
authors.forename: K A
authors.initials: KA
authors.lastname: Bodziak
authors.forename: D E
authors.initials: DE
authors.lastname: Hricik
authors.forename: J J
authors.initials: JJ
authors.lastname: Augustine
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives; D011507:Proteinuria / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D012307:Risk Factors; D020123:Sirolimus / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D013256:Steroids / Q000494:pharmacology / Q000627:therapeutic use; D016559:Tacrolimus / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus