title: Progression of urinary protein excretion after kidney transplantation: A marker for poor long-term prognosis.
abstract: BACKGROUND
  Post-transplantation proteinuria is a risk factor for graft failure. A progressive decline in renal graft function is a predictor for mortality in kidney transplant patients.
  
  
  OBJECTIVE
  To assess the development and the progression of urinary protein excretion (UPE) in the first year post-transplant in recipients of kidney transplants and its effect on patient and graft outcomes.
  
  
  METHODS
  We analysed 1815 patients with 24-h UPE measurements available at 3 and 12 months post-transplant. Patients were divided based on their UPE level: below 300 mg, 300-1000 mg and over 1000 mg (at 3 and 12 months), and changes over time were analysed.
  
  
  RESULTS
  At 3 months, 65.7% had UPE below 300 mg/24 h, 29.6% 300-1000 mg/24 h and 4.7% over 1000 mg/24h. At one year, 71.6% had UPE below 300 mg/24 h, 24.1% 300-1000 mg/24 h and 4.4% over 1000 mg/24 h. In 208 patients (12%), the UPE progressed, in 1233 (70.5%) it remained stable and in 306 (17.5%) an improvement was observed. We found that the level of UPE influenced graft survival, particularly if a progression occurred. Recipient's age and renal function at one year were found to be predictive factors for mortality, while proteinuria and renal function were predictive factors for graft survival.
  
  
  CONCLUSIONS
  Proteinuria after transplantation, essentially when it progresses, is a marker of a poor prognosis and a predictor for graft survival. Progression of proteinuria is associated with poorer renal function and lower graft survival rates.
authors: Servicio de Nefrología, Complejo Hospitalario de Jaén, Jaén, Spain. Electronic address: joborregoh@orange.es.
authors: Josefa
authors: J
authors: Borrego Hinojosa
authors: Servicio de Nefrología, Hospital Virgen del Rocío, Sevilla, Spain.
authors: Miguel Angel
authors: MA
authors: Gentil Govantes
authors: Servicio de Nefrología, Hospital Carlos Haya, Málaga, Spain.
authors: Mercedes
authors: M
authors: Cabello Díaz
authors: Servicio de Nefrología, Hospital Reina Sofía, Córdoba, Spain.
authors: Alberto
authors: A
authors: Rodriguez Benot
authors: Servicio de Nefrología, Hospital Puerta del Mar, Cádiz, Spain.
authors: Auxiliadora
authors: A
authors: Mazuecos Blanca
authors: Servicio de Nefrología, Hospital Virgen de las Nieves, Granada, Spain.
authors: Antonio
authors: A
authors: Osuna Ortega
authors: Servicio de Nefrología Infantil, Hospital Virgen del Rocío, Sevilla, Spain.
authors: Rafael
authors: R
authors: Bedoya Pérez
authors: SAS, Sevilla, Spain.
authors: Pablo
authors: P
authors: Castro De La Nuez
authors: SAS, Sevilla, Spain.
authors: Manuel
authors: M
authors: Alonso Gil
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011507:Proteinuria / Q000453:epidemiology / Q000209:etiology*; D012042:Registries; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D014019:Tissue Donors; D055815:Young Adult
keywords: Graft survival; Kidney transplant; Proteinuria; Supervivencia del injerto; Trasplante renal