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Ortega MJ, Martínez-Belotto M, García-Majado C, Belmar L, López del Moral C, Gómez-Ortega JM, Valero R, Ruiz JC, Rodrigo E. Consequences of Nephrotic Proteinuria and Nephrotic Syndrome after Kidney Transplant. Biomedicines 2024; 12:767. [PMID: 38672122 PMCID: PMC11048274 DOI: 10.3390/biomedicines12040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Proteinuria is the main predictor of kidney graft loss. However, there is little information regarding the consequences of nephrotic proteinuria (NP) and nephrotic syndrome (NS) after a kidney transplant. We aimed to describe the clinical and histopathological characteristics of kidney recipients with nephrotic-range proteinuria and compare the graft surveillance between those who developed NS and those who did not. A total of 204 patients (18.6% of kidney transplants in the study period) developed NP, and 68.1% of them had NS. Of the 110 patients who underwent a graft biopsy, 47.3% exhibited ABMR, 21.8% the recurrence of glomerulonephritis, 9.1% IFTA, and 7.3% de novo glomerulonephritis. After a median follow-up of 97.5 months, 64.1% experienced graft loss. The graft survival after the onset of NP declined from 75.8% at 12 months to 38% at 5 years, without significant differences between those with and those without NS. Patients who developed NS fewer than 3 months after the onset of NP exhibited a significantly higher risk of death-censored graft loss (HR: 1.711, 95% CI: 1.147-2.553) than those without NS or those with late NS. In conclusion, NP and NS are frequent conditions after a kidney transplant, and they imply extremely poor graft outcomes. The time from the onset of NP to the development of NS is related to graft survival.
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Affiliation(s)
- María José Ortega
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Miguel Martínez-Belotto
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Cristina García-Majado
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Lara Belmar
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Covadonga López del Moral
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Jose María Gómez-Ortega
- Pathological Anatomy Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain
| | - Rosalía Valero
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Juan Carlos Ruiz
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
| | - Emilio Rodrigo
- Immunopathology Group, Nephrology Department, Marqués de Valdecilla University Hospital-IDIVAL, University of Cantabria, 39012 Santander, Spain (C.L.d.M.); (R.V.); (J.C.R.)
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Dai Z, Ye L, Chen D, Zhang X, Wang M, Wang R, Wu J, Chen J. Effect of earlier-proteinuria on graft functions after one-year living donor renal transplantation. Oncotarget 2017; 8:59103-59112. [PMID: 28938621 PMCID: PMC5601717 DOI: 10.18632/oncotarget.19260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/27/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Proteinuria is an indicator of subsequent renal function decline in most nephropathies and early proteinuria has been assumed to be a risk factor of poor kidney transplant outcomes. However, there is no information about the effect of earlier-proteinuria at the first week on short-term graft function after living donor renal transplantation. METHODS Retrospective cohort study of 439 living donor kidney transplants to analyze the effect of early proteinuria at 7-day post-transplantation on short-term prognosis of living donor renal transplantation. Patients were stratified into 2 groups according to the definition of earlier-proteinuria: Group A as proteinuria < 0.4 g/24h and Group B as proteinuria ≥ 0.4 g/24h, and differences over the first year post-transplantation were analyzed. RESULTS Patients with earlier-proteinuria ≥ 0.4 g/24h had a significantly higher 1-year proteinuria and lower 1-year graft function post-transplantation. Discrepancies of weight ratio of donor-recipient and mean artery pressure difference of recipient to donor influenced the urine protein excretion at the 7-day post-transplantation. CONCLUSIONS Earlier-proteinuria at 7-day after living donor renal transplantation was associated with short-term graft function. To eliminate the functional discrepancies between living donors and recipients could be viewed as a solution of reducing earlier-proteinuria.
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Affiliation(s)
- Zaiyou Dai
- Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
- The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China
- Department of Nephrology, The First People's Hospital of Wenling, Zhejiang, China
| | - Luxi Ye
- Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
- The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China
| | - Dajin Chen
- Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
- The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China
| | - Xing Zhang
- Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
- The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China
| | - Meifang Wang
- Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
- The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China
| | - Rending Wang
- Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
- The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China
| | - Jianyong Wu
- Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
- The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China
| | - Jianghua Chen
- Department of The Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang, China
- The Third Grade Laboratory under The National State, Administration of Traditional Chinese Medicine, Zhejiang, China
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