Emergence of Dipstick Proteinuria Predicts Overt Nephropathy in Patients Following Stem Cell Transplantation.
BACKGROUND
Stem cell transplantation (SCT) places a heavy burden on the kidneys, often resulting in renal dysfunction or nephrotic syndrome. This study attempted to show that early-onset proteinuria predicts the development of overt nephropathy.


METHODS
A total of 831 patients who received allogeneic SCT were surveyed. Excluding those with prior kidney disease and those lacking in an observation period ≥1 year after SCT, 251 patients were eligible for the study. Dipstick proteinuria ≥1+ within 1 year after SCT was defined as 'incident proteinuria', and subsequent persistence of an estimated glomerular filtration rate of <60 ml/min/1.73 m2 at 1 year or longer after SCT was defined as 'incident chronic kidney disease (CKD)'. Between-group differences were analyzed using the chi-square or Mann-Whitney U test. Factors associated with the incidence of CKD were investigated by multivariate Cox proportional regression analysis. Kidney-biopsied tissue was examined in all nephrotic syndrome patients.


RESULTS
The mean duration of follow-up was 4 years. Thirty-four (13.5%) and 66 (26.3%) patients developed incident proteinuria and incident CKD, respectively. Nine (3.6%) patients developed nephrotic syndrome mainly due to membranous nephropathy. The incidence of CKD was significantly greater in patients with incident proteinuria than those without (61.8 vs. 20.7%, p < 0.0001), and incident dipstick proteinuria was a significant risk for incident CKD (hazard ratio 4.39, 95% CI 2.44-7.73, p < 0.0001).


CONCLUSIONS
SCT patients who manifest dipstick proteinuria are predisposed to overt nephropathy. Routine monitoring of the urine dipstick test is strongly recommended, as it facilitates early nephrology care for post-SCT patients.
Department IV of Internal Medicine, Tokyo Women's Medical University, Tokyo, Japan.
Kumiko
K
Momoki
Tsukasa
T
Yamaguchi
Kazuteru
K
Ohashi
Minoru
M
Ando
Kosaku
K
Nitta
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000209:etiology; D011507:Proteinuria / Q000175:diagnosis / Q000209:etiology* / Q000652:urine; D051436:Renal Insufficiency, Chronic / Q000209:etiology; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects*