An Observational Study on Etiology of Proteinuria in Postrenal Transplant Recipients in a Tertiary Hospital of North India
Published: 2024-06-04
Page: 45-52
Issue: 2024 - Volume 7 [Issue 1]
Gigin SV *
Department of Nephrology, SMS Medical Collage, Jaipur, Rajasthan, India.
Dhananjai Agarwal
Department of Nephrology, SMS Medical Collage, Jaipur, Rajasthan, India.
Pankaj Beniwal
Department of Nephrology, SMS Medical Collage, Jaipur, Rajasthan, India.
Rakesh Gupta
Department of Nephrology, SMS Medical Collage, Jaipur, Rajasthan, India.
*Author to whom correspondence should be addressed.
Abstract
The presence of proteinuria from native kidneys is hard to interpret when detected after transplantation. Studies show that pre-transplant proteinuria, even within the nephrotic range, abruptly reduces during the first weeks after receiving a normal functioning kidney transplant. Immunosuppressive medications, such as calcineurin inhibitors (e.g., cyclosporine, tacrolimus), can cause nephrotoxicity and result in proteinuria. Urinary tract infections (UTIs), can cause proteinuria. Studies have found that proteinuria doubled the risk of graft failure in comparison with non proteinuric transplant recipients Risk for death was almost twice as high for patients with proteinuria at 1 year.
Keywords: Proteinuric transplant recipients, proteinuria, kidney transplant, kidney transplantation
How to Cite
References
Knoll GA. Proteinuria in kidney transplant recipients: prevalence, prognosis, and evidence-based management. Am J Kidney Dis. 2009;54:1131-44. [Pubmed]
First MR, Vaidya PN, Maryniak RK, Weiss MA, Munda R, Fidler JP, et al. Proteinuria following transplantation. Correlation with histopathology and outcome. Transplantation. 1984;38:607-12.
Myslak M, Amer H, Morales P, Fidler ME, Gloor JM, Larson TS, et al. Interpreting post-transplant proteinuria in patients with proteinuria pre-transplant. Am J Transplant. 2006;6:1660-5. [Pubmed]
D'Cunha PT, Parasuraman R, Venkat KK. Rapid resolution of proteinuria of native kidney origin following live donor renal transplantation. Am J Transplant. 2005; 5:351-5. [Pubmed]
Pinto J, Lacerda G, Cameron JS, Turner DR, Bewick M, Ogg CS. Recurrence of focal segmental glomerulosclerosis in renal allografts. Transplantation. 1981;32:83-9. [Pubmed]
Dabade TS, Grande JP, Norby SM, Fervenza FC, Cosio FG. Recurrent idiopathic membranous nephropathy after kidney transplantation: A surveillance biopsy study. Am J Transplant. 2008; 8(6):1318. [Pubmed]
Sethi S, Zand L, Leung N, Smith RJ, Jevremonic D, Herrmann SS, et al. Membranoproliferative glomerulonephritis secondary to monoclonal gammopathy. Clin J Am Soc Nephrol. 2010;5:770- 82.
Sethi S, Fervenza FC, Zhang Y, Nasr SH, Leung N, Vrana J, et al. Proliferative glomerulonephritis secondary to dysfunction of the alternative pathway of complement. Clin J Am Soc Nephrol. 2011;6:1009-17. [Pubmed]
Lorenz EC, Sethi S, Leung N, Dispenzieri A, Fervenza FC, Cosio FG. Recurrent membranoproliferative glomerulonephritis after kidney transplantation. Kidney Int. 2010;77:721-8. [Pubmed]
Berthoux FC, Ducret F, Colon S, Blanc-Brunat N, Zech PY, Traeger J. Renal transplantation in mesangioproliferative glomerulonephritis (MPGN): Relationship between the high frequency of recurrent glomerulonephritis and hypocomplementemia. Kidney Int. 1975; 7:323-7.
Zipfel PF, Heinen S, Jozsi M, Skerka C. Complement and diseases: Defective alternative pathway control results in kidney and eye diseases. Mol Immunol. 2006;43:97-106. [Pubmed]
El-Zoghby ZM, Stegall MD, Lager DJ, Kremers WK, Amer H, Gloor JM, et al. Identifying specific causes of kidney allograft loss. Am J Transplant. 2009;9:527-35. [Pubmed]
Cosio FG, Frankel W, Pelletier R, Pesavento T, Henry M, Ferguson R. Focal segmental glomerulosclerosis in renal allografts with chronic nephropathy: implications for graft survival. Am J Kidney Dis. 1999;34:731-8. [Pubmed]
Amer H, Fidler ME, Myslak M, Morales P, Kremers WK, Larson TS, et al. Proteinuria after kidney transplantation, relationship to allograft histology and survival. Am J Transplant. 2007;7:2748-56. [Pubmed]
Harlan WR Jr., Holden KR, Williams GM, Hume DM. Proteinuria and nephrotic syndrome associated with chronic rejection of kidney transplants. N Engl J Med. 1967;277:769-76. [Pubmed]
Hood B, Olander R, Nagy Z, Bergentz SE. Glomerulopathy in the transplanted kidney. Scand J Urol Nephrol. 1970;4:135-42. [Pubmed]
Cosio FG, Gloor JM, Sethi S, Stegall MD. Transplant glomerulopathy. Am J Transplant. 2008;8:492-6. [Pubmed]
Wavamunno MD, O'Connell PJ, Vitalone M, Fung CL, Allen RD, Chapman JR, et al. Transplant glomerulopathy: Ultrastructural abnormalities occur early in longitudinal analysis of protocol biopsies. Am J Transplant. 2007;7:2757-68. [Pubmed]
Solez K, Colvin RB, Racusen LC, Haas M, Sis B, Mengel M, et al. Banff 07 classification of renal allograft pathology: updates and future directions. Am J Transplant. 2008;8:753-60. [Pubmed]
Russo LM, Sandoval RM, McKee M, Osicka TM, Collins AB, Brown D, et al. The normal kidney filters nephrotic levels of albumin retrieved by proximal tubule cells: Retrieval is disrupted in nephrotic states. Kidney Int. 2007;71:504-13. [Pubmed]
Letavernier E, Pe'raldi MN, Pariente A, Morelon E, Legendre C. Proteinuria following a switch from calcineurin inhibitors to sirolimus. Transplantation. 2005;80:1198-203. [Pubmed]
Lorber MI, Mulgaonkar S, Butt KM, Elkhammas E, Mendez R, Rajagopalan PR, et al. Everolimus versus mycophenolate mofetil in the prevention of rejection in de novo renal transplant recipients: a 3-year randomized, multicenter, phase III study. Transplantation. 2005;80:244-52. [Pubmed]
Letavernier E, Bruneval P, Vandermeersch S, Perez J, Mandet C, Belair MF, et al. Sirolimus interacts with pathways essential for podocyte integrity. Nephrol Dial Transplant. 2009;24:630-8. [Pubmed]
Biancone L, Bussolati B, Mazzucco G, Barreca A, Gallo E, Rossetti M, et al. Loss of nephrin expression in glomeruli of kidney-transplanted patients under m-TOR inhibitor therapy. Am J Transplant. 2010; 10(10):2270. [Pubmed]
Stallone G, Infante B, Pontrelli P, Gigante M, Montemurno E, Loverre A, et al. Sirolimus and proteinuria in renal transplant patients: Evidence for a dose-dependent effect on slit diaphragm-associated proteins. Transplantation. 2011; 91:997-1004. [Pubmed]
Diekmann F, Budde K, Oppenheimer F, Fritsche L, Neumayer HH, Campistol JM. Predictors of success in conversion from calcineurin inhibitor to sirolimus in chronic allograft dysfunction. Am J Transplant. 2004;4:1869-75. [Pubmed]