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Impact of patterns of proteinuria on renal allograft function and survival: a prospective cohort study
Author(s) -
Suhail S.M.,
Kee T.S.Y.,
Woo K.T.,
Tan H.K.,
Yang W.S.,
Chan C.M.,
Foo M.W.Y.,
Li H.H.,
Siddique M.M.,
Wong K.S.
Publication year - 2011
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2011.01415.x
Subject(s) - proteinuria , medicine , hazard ratio , prospective cohort study , renal function , urology , proportional hazards model , confidence interval , creatinine , transplantation , kidney transplantation , cohort , gastroenterology , surgery , kidney
Suhail SM, Kee TSY, Woo KT, Tan HK, Yang WS, Chan CM, Foo MWY, Li HH, Siddique MM, Wong KS. Impact of patterns of proteinuria on renal allograft function and survival: a prospective cohort study.
Clin Transplant 2011: 25: E297–E303. © 2011 John Wiley & Sons A/S. Abstract: Background: Proteinuria is an important complication in renal transplant recipients. The aim of this prospective study was to evaluate the long‐term impact of transplant proteinuria patterns on allograft function and survival. Methods: We analyzed urinary protein of a cohort of 83 renal transplants with proteinuria ≥0.5 g/d by sodium dodecyl sulfate–polyacrylamide gel electrophoresis and radial immunogel diffusion assay. After initial stratification and analysis, the cohort was followed up for 16 yr. The graft outcome and survival were analyzed using Cox regression model to determine their association with different patterns of initial transplant proteinuria. Results: Group with predominantly glomerular (middle‐ and high‐molecular‐weight with or without low‐molecular‐weight) proteinuria (61%) had higher serum creatinine (p < 0.001) than the group with predominantly tubular (low‐molecular‐weight) proteinuria (39%). The incidences of chronic graft dysfunction and graft loss had increased in the glomerular proteinuria group (p < 0.001, hazard ratio 3.6, 95% confidence interval 1.7–7.5 and p < 0.001, hazard ratio 4.9, 95% confidence interval 1.9–12.1, respectively). Patient death did not differ (p = 0.434, hazard ratio 1.5, 95% confidence interval 0.5–4.5). Conclusion: Proteinuria in renal transplants can be differentiated into glomerular and tubular types based on molecular weight. Glomerular proteinuria is associated with significant increase in graft dysfunction and graft loss.