Premium
Early Low‐Grade Proteinuria: Causes, Short‐Term Evolution and Long‐Term Consequences in Renal Transplantation
Author(s) -
Halimi JeanMichel,
Laouad Inass,
Buchler Matthias,
AlNajjar Azmi,
Chatelet Valérie,
Houssaini Tarik Sqalli,
Nivet Hubert,
Lebranchu Yvon
Publication year - 2005
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2005.01020.x
Subject(s) - proteinuria , medicine , transplantation , urology , kidney transplantation , hazard ratio , cardiology , kidney , gastroenterology , confidence interval
Proteinuria 1 year after transplantation is associated with poor renal outcome. It is unclear whether low‐grade (<1 g/24 h) proteinuria earlier after transplantation and its short‐term change affect long‐term graft survival. The effects of proteinuria and its change on long‐term graft survival were retrospectively assessed in 484 renal transplant recipients. One‐ and 3‐month proteinuria correlated with donor age, donor cardiovascular death, prolonged cold and warm ischemia times and acute rejection. One‐ and 3‐month proteinuria (per 0.1 g/24 h, hazard ratio (HR): 1.07 and 1.15, p < 0.0001)—especially low‐grade proteinuria (HR: 1.20 and 1.26, p < 0.0001)—were powerful, independent predictors of graft loss. Its short‐term reduction correlated with arterial pressure (AP) (the lower the 3‐month diastolic and 12‐month systolic AP, the lower the risk of increasing proteinuria during 1–3 months and 3–12 months periods, respectively: Odds ratio (OR) per 10 MmHg: 0.78, p = 0.01 and 0.85, respectively, p = 0.02), and was associated with decreased long‐term graft loss (per 0.1 g/24 h: HR: 0.88 and 0.98, respectively, p < 0.0001), independently of initial proteinuria. Early low‐grade proteinuria due to pre‐transplant renal lesions, ischemia‐reperfusion and immunologic injuries is a potent predictor of graft loss. Short‐term reduction in proteinuria is associated with improved long‐term graft survival.