Transplant kidney biopsy for proteinuria with stable creatinine: Findings and outcomes.
biopsy
outcomes
proteinuria
rejections
Journal
Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
revised:
08
07
2021
received:
29
05
2021
accepted:
19
07
2021
pubmed:
23
7
2021
medline:
3
2
2022
entrez:
22
7
2021
Statut:
ppublish
Résumé
Little is known aboutbiopsy findings and outcomes when kidney transplant recipients (KTRs) undergo biopsy for isolated proteinuria with stable serum creatinine (SCr). We analyzed all KTRs who underwent biopsy for isolated proteinuria with stable SCr between January 2016 and June 2020. Patients were divided into three groups based on the biopsy findings: Active Rejection (AR), Glomerulonephritis (GN), and Other. A total of 130 KTRs fulfilled our selection criteria; 38 (29%) in the AR group, 26 (20%) in the GN group, and 66 (51%) in the Other group. Most baseline characteristics were similar between the groups. In multivariate analysis, higher HLA mismatch (HR per mismatch: 1.30; 95% CI:1.06-1.59; P = .01) and male gender (HR: .45; 95% CI .23-.89; P = .02) were associated with AR. There was no significant correlation between the degree of proteinuria and rejection (r = .05, P = .58) or GN (r = .07, P = .53). Graft survival was also similar between the groups. Likely due to the early diagnosis without a significant rise in SCr, outcomes were similar among all three groups. Routine monitoring for proteinuria followed by a biopsy and appropriate management may help to identify early acute graft injury and prevent graft failure.
Substances chimiques
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e14436Subventions
Organisme : Virginia Lee Cook Foundation
Informations de copyright
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
First MR, Vaidya PN, Maryniak RK, et al. Proteinuria following transplantation. Correlation with histopathology and outcome. Transplantation. 1984;38:607-612.
Fernández-Fresnedo G, Plaza JJ, Sánchez-Plumed J, Sanz-Guajardo A, Palomar-Fontanet R, Arias M. Proteinuria: a new marker of long-term graft and patient survival in kidney transplantation. Nephrol Dial Transplant. 2004;19(3):iii47-51.
López V, Sola E, Jironda C, et al. Biopsies in renal transplant patients with proteinuria: histological findings. Transplant Proc. 2011;43:2191-2193.
Reichel H, Zeier M, Ritz E. Proteinuria after renal transplantation: pathogenesis and management. Nephrol Dial Transplant. 2004;19:301-305.
Morath C, Zeier M. When should post-transplantation proteinuria be attributed to the renal allograft rather than to the native kidney?. Nat Clin Pract Nephrol. 2007;3:18-19.
Fernández-Fresnedo G, Escallada R, Rodrigo E, et al. The risk of cardiovascular disease associated with proteinuria in renal transplant patients. Transplantation. 2002;73:1345-1348.
Roodnat JI, Mulder PG, Rischen-Vos J, et al. Proteinuria after renal transplantation affects not only graft survival but also patient survival. Transplantation. 2001;72:438-444.
Shamseddin MK, Knoll GA. Posttransplantation proteinuria: an approach to diagnosis and management. Clin J Am Soc Nephrol. 2011;6:1786-1793.
Amer H, Fidler ME, Myslak M, et al. Proteinuria after kidney transplantation, relationship to allograft histology and survival. Am J Transplant. 2007;7:2748-2756.
Yakupoglu U, Baranowska-Daca E, Rosen D, Barrios R, Suki WN, Truong LD. Post-transplant nephrotic syndrome: a comprehensive clinicopathologic study. Kidney Int. 2004;65:2360-2370.
Parajuli S, Reville PK, Ellis TM, Djamali A, Mandelbrot DA. Utility of protocol kidney biopsies for de novo donor-specific antibodies. Am J Transplant. 2017;17:3210-3218.
Parajuli S, Astor BC, Kaufman D, et al. Which is more nephrotoxic for kidney transplants: BK nephropathy or rejection?. Clin Transplant. 2018;32:e13216.
Tsampalieros A, Knoll GA. Evaluation and management of proteinuria after kidney transplantation. Transplantation. 2015;99:2049-2060.
Akbari A, Fergusson D, Kokolo MB, et al. Spot urine protein measurements in kidney transplantation: a systematic review of diagnostic accuracy. Nephrol Dial Transplant. 2014;29:919-926.
Krishna KS, Pandey AP, Kirubakaran MG, Kanagasabapathy AS. Urinary protein/creatinine ratio as an indicator of allograft function following live related donor renal transplantation. Clin Chim Acta. 1987;163:51-61.
D'Cunha PT, Parasuraman R, Venkat KK. Rapid resolution of proteinuria of native kidney origin following live donor renal transplantation. Am J Transplant. 2005;5:351-355.
Sun Q, Jiang S, Li X, et al. The prevalence of immunologic injury in renal allograft recipients with de novo proteinuria. PLoS One. 2012;7:e36654.
Serón D, Burgos D, Alonso A. Histology and proteinuria after renal transplantation. Transplant Rev (Orlando). 2012;26:20-26.
Naesens M, Lerut E, Emonds MP, et al. Proteinuria as a noninvasive marker for renal allograft histology and failure: an observational cohort study. J Am Soc Nephrol. 2016;27:281-292.
Parajuli S, Joachim E, Alagusundaramoorthy S, et al. Subclinical antibody-mediated rejection after kidney transplantation: treatment outcomes. Transplantation. 2019;103:1722-1729.
Redfield RR, McCune KR, Rao A, et al. Djamali A: nature, timing, and severity of complications from ultrasound-guided percutaneous renal transplant biopsy. Transpl Int. 2016;29:167-172.
Parajuli S, Joachim E, Alagusundaramoorthy S, et al. Donor-specific antibodies in the absence of rejection are not a risk factor for allograft failure. Kidney Int Rep. 2019;4:1057-1065.
Kataria A, Kumar D, Gupta G. Donor-derived Cell-free DNA in solid organ transplant diagnostics: indications, limitations, and future directions. Transplantation. 2021.