title: Impact of patterns of proteinuria on renal allograft function and survival: a prospective cohort study.
abstract: BACKGROUND
  Proteinuria is an important complication in renal transplant recipients. The aim of this prospective study was to evaluate the long-term impact of transplant proteinuria patterns on allograft function and survival.
  
  
  METHODS
  We analyzed urinary protein of a cohort of 83 renal transplants with proteinuria ≥0.5 g/d by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and radial immunogel diffusion assay. After initial stratification and analysis, the cohort was followed up for 16 yr. The graft outcome and survival were analyzed using Cox regression model to determine their association with different patterns of initial transplant proteinuria.
  
  
  RESULTS
  Group with predominantly glomerular (middle- and high-molecular-weight with or without low-molecular-weight) proteinuria (61%) had higher serum creatinine (p < 0.001) than the group with predominantly tubular (low-molecular-weight) proteinuria (39%). The incidences of chronic graft dysfunction and graft loss had increased in the glomerular proteinuria group (p < 0.001, hazard ratio 3.6, 95% confidence interval 1.7-7.5 and p < 0.001, hazard ratio 4.9, 95% confidence interval 1.9-12.1, respectively). Patient death did not differ (p = 0.434, hazard ratio 1.5, 95% confidence interval 0.5-4.5).
  
  
  CONCLUSIONS
  Proteinuria in renal transplants can be differentiated into glomerular and tubular types based on molecular weight. Glomerular proteinuria is associated with significant increase in graft dysfunction and graft loss.
authors.affiliation: Department of Renal Medicine Department of Clinical Research Duke-NUS Graduate Medical School, Singapore. grmsms@sgh.com.sg
authors.forename: S M
authors.initials: SM
authors.lastname: Suhail
authors.forename: T S Y
authors.initials: TS
authors.lastname: Kee
authors.forename: K T
authors.initials: KT
authors.lastname: Woo
authors.forename: H K
authors.initials: HK
authors.lastname: Tan
authors.forename: W S
authors.initials: WS
authors.lastname: Yang
authors.forename: C M
authors.initials: CM
authors.lastname: Chan
authors.forename: M W Y
authors.initials: MW
authors.lastname: Foo
authors.forename: H H
authors.initials: HH
authors.lastname: Li
authors.forename: M M
authors.initials: MM
authors.lastname: Siddique
authors.forename: K S
authors.initials: KS
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology*; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D055815:Young Adult