Post-transplant nephrotic syndrome: A comprehensive clinicopathologic study

Ulkem Yakupoglu, Elzbieta Baranowska-Daca, Daniel Rosen, Roberto Barrios, Wadi N. Suki, Luan D. Truong

Research output: Contribution to journalArticle

46 Scopus citations

Abstract

Background. Post-transplant (Tx) nephrotic syndrome (NS) is not well defined. Methods. Seventy-four renal transplant recipients with NS were studied. Results. Biopsies showed chronic allograft nephropathy (CAN) in 31 patients; recurrent glomerular disease (GN) in 15, de novo GN in 18, and undetermined GN in 9. NS developed 0.25 to 384 months post-Tx and was treated with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) in 18 patients; calcium channel blockers in 25; or both drugs in 31. NS remitted in 24% of cases 2 to 28 months after onset, and this persisted in all except 3 patients. The remission rate was lowest (9%) for CAN and highest (47%) for de novo GN. Compared with persistent NS, those with remission showed higher prevalence of de novo GN (53% vs. 17%), lower prevalence of CAN (18% vs. 50%), earlier onset of NS (39 vs. 59 months), lower serum SCr at onset (2.3 vs. 2.9 mg/dL), and higher incidence of treatment with ACE or ARB. The 5-year graft loss rates for CAN, recurrent and de novo GN were 57%, 36%, and 23%, respectively. Compared with the functioning grafts, the failed grafts showed higher prevalence of CAN (60% vs. 16%), lower prevalence of de novo GN (12% vs. 46%), earlier onset of NS (47 vs 65 months post-Tx), higher serum SCr at onset (3.3 vs. 2.0 mg/dL), lower prevalence of remission of NS (5% vs. 48%), and higher proteinuria at follow-up (5.1 vs. 2.5 g/day). Graft survival improved with NS remission (88% vs. 18%). Conclusion. Post-Tx NS displays distinctive clinicopathologic features with pathogenetic and therapeutic implications.

Original languageEnglish (US)
Pages (from-to)2360-2370
Number of pages11
JournalKidney international
Volume65
Issue number6
DOIs
StatePublished - Jun 2004

Keywords

  • Chronic allograft nephropathy
  • De novo glomerular diseases
  • Graft failure
  • Heavy proteinuria
  • Post-transplant nephrotic syndrome
  • Recurrent glomerular diseases
  • Remission
  • Renal transplant biopsy

ASJC Scopus subject areas

  • Nephrology

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