Risk Factors And Prognosis For Proteinuria In Renal Transplant Recipients

Background.Proteinuria is a sensitive marker of renal dysfunction.The proteinuria in renal allograft recipients has been regarded as a sign of poor prognosis.The cause of post-transplant proteinuria include chronic rejection,glomerulonephritis,acute rejection and cyclosporine nephrotoxicity.Among them, chronic rejection is known to be most frequent.The purpose of the present study was to investigate risk factors of the persistent proteinuria and whether persistent proteinuria was associated with poor graft outcome.Methods.This study included 178 patients who had first renal transplantation in Huashan hospital.The patients were divided into two groups according to their level of urinary protein excretion.We recorded clinical and laboratory data for each patient,including gender,age at transplantation,donor status(living or cadaveric), duration of pretransplant dialysis,presence of acute rejection,systolic and diastolic blood pressure levels,immuno- suppressive treatment,graft survival and so on. Statistical analyses were performed with SPSS software.we compared categorical variables with the chi-square test;and continuous variables with one-way anova or Kruskall-Wallis;Kaplan-Meier curves were use to calculate graft survival(log-rank test).Logistic regression analysis was performed to estimate relative risks(RR) for independent variables of protenuria following renal transplantation.Cox proportional hazards regression models were used to examine the relationship of variables with survival.P values less than.05 were considered significant.Results.After a mean follow-up of 20 months,43 patients(24.16%) were found to have persistent proteinuria.Hepatitis C(P =0.009),transfusion(P =0.022),induction treatment(P=0.026),cholestero(P<0.001)and LDL(P<0.001)were associated with proteinuria.Multivariate analysis confirmed the independent value of Hepatitis C (OR =7.426;95%confidence interval[CI]1.239 to 44.493;P=0.028) to predict postransplant proteinuria.The mean percentage of decline in serum creatinine per month was persistently higher from the early stages after transplantation in the proteinuric group.Graft survival was 70%among patients who developed proteinuria and 93%in those without proteinuria(P<0.001).Cox proportional hazards regression models confirmed the independent value of protenuira(RR =8.405;95%confidence interval[CI]1.174 to 60.168;P=0.034) to predict graft survival.Conclusion.Proteinuria in renal transplant recipients was related to Hepatitis C,transfusion,Induction treatment,cholestero and LDL.Proteinuria in renal transplant recipients predicted a worse allograft survival.