TY - JOUR
T1 - Chronic allograft nephropathy and nephrotic range proteinuria
AU - Ramanathan, Venkataraman
AU - Suki, Wadi N.
AU - Rosen, Daniel
AU - Truong, Luan
PY - 2005/6
Y1 - 2005/6
N2 - While the association between post-transplant nephrotic range proteinuria (PTx-NP) and chronic allograft nephropathy (CAN) has been described, the factors that determine graft survival in such patients are unclear. We retrospectively identified 30 patients with biopsy-proven CAN who presented with PTX-NP between 1988 and 2002. Patients were stratified into two groups according to PTX-NP onset: < 1 yr vs. > 1 yr post-transplantation. Both groups were comparable with respect to the degree of renal dysfunction (serum creatinine 4.3 ± 2.5 mg/dL vs. 3.4 ± 1.5 mg/dL) and proteinuria (4.7 ± 1.6 gm/d vs. 5.8 ± 3 gm/d). After a mean follow-up of 14 months post-biopsy, 87% of patients had lost their grafts in both groups (89% vs. 83%, p = NS). Overall, patients with serum creatinine ≤ 2 mg/dL had better graft survival during follow-up than patients with serum creatinine > 2 mg /dL (75% vs. 4%, Fisher Exact Probability p = 0.0038). Using Kaplan-Meier estimate, the 5-yr graft survival rate was 100% for patients with serum creatinine ≤ 2 mg/dL and 40% in those with > 2 mg/dL (p = 0.06). The magnitude of proteinuria beyond 3 gm/d did not influence graft survival. One-half of the patients (n = 15) received therapy with angiotensin converting enzyme inhibitors (ACEI). Graft survival, however, was not different between the patients who received ACEI compared with the patients who did not receive ACEI (13% vs. 13%). PTx-NP related to CAN was associated with poor allograft survival, irrespective of the time of onset of presentation, especially when renal function was reduced at the time of biopsy.
AB - While the association between post-transplant nephrotic range proteinuria (PTx-NP) and chronic allograft nephropathy (CAN) has been described, the factors that determine graft survival in such patients are unclear. We retrospectively identified 30 patients with biopsy-proven CAN who presented with PTX-NP between 1988 and 2002. Patients were stratified into two groups according to PTX-NP onset: < 1 yr vs. > 1 yr post-transplantation. Both groups were comparable with respect to the degree of renal dysfunction (serum creatinine 4.3 ± 2.5 mg/dL vs. 3.4 ± 1.5 mg/dL) and proteinuria (4.7 ± 1.6 gm/d vs. 5.8 ± 3 gm/d). After a mean follow-up of 14 months post-biopsy, 87% of patients had lost their grafts in both groups (89% vs. 83%, p = NS). Overall, patients with serum creatinine ≤ 2 mg/dL had better graft survival during follow-up than patients with serum creatinine > 2 mg /dL (75% vs. 4%, Fisher Exact Probability p = 0.0038). Using Kaplan-Meier estimate, the 5-yr graft survival rate was 100% for patients with serum creatinine ≤ 2 mg/dL and 40% in those with > 2 mg/dL (p = 0.06). The magnitude of proteinuria beyond 3 gm/d did not influence graft survival. One-half of the patients (n = 15) received therapy with angiotensin converting enzyme inhibitors (ACEI). Graft survival, however, was not different between the patients who received ACEI compared with the patients who did not receive ACEI (13% vs. 13%). PTx-NP related to CAN was associated with poor allograft survival, irrespective of the time of onset of presentation, especially when renal function was reduced at the time of biopsy.
KW - Chronic allograft nephropathy
KW - Graft failure
KW - Post-transplant nephrotic syndrome
KW - Proteinuria
KW - Transplant biopsy
UR - http://www.scopus.com/inward/record.url?scp=19044370014&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=19044370014&partnerID=8YFLogxK
U2 - 10.1111/j.1399-0012.2005.00366.x
DO - 10.1111/j.1399-0012.2005.00366.x
M3 - Article
C2 - 15877807
AN - SCOPUS:19044370014
SN - 0902-0063
VL - 19
SP - 413
EP - 417
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 3
ER -