Abstract

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.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalClinical Transplantation
Volume19
Issue number3
DOIs
StatePublished - Jun 1 2005

Keywords

  • Chronic allograft nephropathy
  • Graft failure
  • Post-transplant nephrotic syndrome
  • Proteinuria
  • Transplant biopsy

ASJC Scopus subject areas

  • Transplantation
  • Immunology

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