Effect Of Earlier-proteinuria On Graft Functions After One-year Living Donor Renal Transplantation

Background and Objective:Proteinuria is not only a marker of kidney damage,but also an independent risk factor for the progression of chronic renal failure.Like proteinuria in common chronic kidney disease,long-term proteinuria after kidney transplantation suggests that graft function will gradually diminish,eventually leading to renal failure.On the incidence of albuminuria after transplantation,reported in the literature ranging from 7.5%～45%.The occurrence of early or long-term proteinuria after surgery is related to the recurrence of existing kidney disease,chronic allograft nephropathy,drug side effects,rejection,etc.The persistence of long-term proteinuria affects the survival of long-term transplanted kidneys.Studies have confirmed that:proteinuria early 3M after renal transplantation,renal transplant recipients will affect 1 year,3 years and other long-term renal function,after 3 months still crawl proteinuria often prompt chronic kidney transplant kidney disease or the original Nephrotic relapse,but also affect long-term renal graft function.Changes in proteinuria in the early postoperative week were less studied,Artz et al.Conducted a related study on the change trend of early proteinuria after kidney transplantation.This study suggests that a large amount of proteinuria is produced immediately after renal transplantation,and the urinary protein is gradually decreasing.However,the number of cases in this study is small,and there is no short-term renal transplantation after the first week after surgery.There was no study on the effect of early proteinuria in the first postoperative week on short-term graft renal function after renal transplantation,and the reasons for the occurrence of early proteinuria were not further elaborated.This article aims to analyze the incidence of early proteinuria and its causes after living donor kidney transplantation,and to explore its impact on short-term renal graft function after 1 year.Object and Methods:A retrospective cohort study of 439 living donor kidney transplant patients collected donor and recipient-relevant clinical data.From the second day to the seventh day after surgery,all patients were continuously measured for 24-hour urinary protein quantification every day and after transplantation.Urinary protein is routinely measured at months 1,3,6,9 and 12.At the same time,serum creatinine was measured in all patients from day 2 to day 7 and at months 1,3,6,9 and 12 after transplantation,or until the recipient had lost graft power within 1 year.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.The relationship between proteinuria at 7 days after transplantation and renal function at 1 year after transplantation was analyzed,as well as the factors that affected the occurrence of early proteinuria.Results:During the first week after transplantation,the recipient’s urinary protein excretion gradually decreased,usually falling rapidly from the second day to the fourth day,and slowly decreasing in the last three days.Compared with group A,donors in group B had fewer men and were lighter in weight,and donors had lower preoperative mean arterial pressure(MAP).In group B,donor-to-recipient weight ratios were relatively small,receiver-donor MAP difference is greater.Proteinuria in patients with early proteinuria≥0.4 g/24h was significantly higher,and renal function was significantly worse at 1 year after transplantation.Early proteinuria ≥ 0.4 g/24h,postoperative renal function and donor age on the 7th day were significantly associated with renal function at 1-year follow-up.Both donor-recipient weight ratios and recipient-donor MAP differences affected urinary protein excretion 7 days after transplantation:the lower the donor-recipient weight ratio,the greater the recipient-donor MAP difference The risk of proteinuria in the first week after transplantation is higher.Conclutions:The proteinuria in the first week after kidney transplantation for living donors showed a downward trend.Proteinuria on the seventh day was related to the short-term graft function after one year.The donor-recipient’s weight ratio and the donor-donor MAP difference all affected the transplantation.After 7 days of urinary protein excretion.By reducing the difference between donor and recipient weights and MAP differences,it may be possible to reduce the effects of early proteinuria and decreased proteinuria on graft function.