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Proteinuria 1 year after renal transplantation is associated with impaired graft survival in children

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Abstract

Background

Proteinuria is a common manifestation of chronic kidney disease (CKD), and there is a high incidence of CDK and its complications following renal transplantation. However, little data are available on the association between proteinuria and graft/patient survival in the paediatric transplant population. The primary aim of this study was to investigate the associations between posttransplant proteinuria and graft/patient survival in children after renal transplantation.

Methods

In this retrospective study, we screened all 91 children receiving renal allografts at a single institution between 1997 and 2007. The inclusion criteria were a functioning graft at 1 year posttransplant, data availability and no recurrence of focal-segmental glomerulosclerosis. The final cohort included 75 patients. Proteinuria was considered to be pathologic if the urinary protein/creatinine ratio was >30 mg/mmol. Donor and recipient characteristics, data on proteinuria, estimated glomerular filtration rate (eGFR) and rejection episodes were analysed. The most recent of the biopsies performed during the follow-up after 1 year posttransplant were analysed separately in the proteinuric group and the non-proteinuric group.

Results

Proteinuria at 1-year posttransplant was pathologic in 35 % of patients. The 5-year graft survival rate was significantly lower in the proteinuric group than in the non-proteinuric group (77 vs. 100 %; p < 0.001). Proteinuria at 1 year posttransplant was associated with reduced long-term graft survival independent of other risk factors, including decreased eGFR or episodes of acute corticosensitive and corticoresistant rejection. The most frequent histologic finding in the proteinuric group was chronic rejection. There was no significant difference in the 5-year patient survival rate between the proteinuric group and the non-proteinuric group.

Conclusion

This study emphasizes the importance of proteinuria as a prognostic factor of renal allograft survival in children.

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Acknowledgements

This work was supported by the project ED 2.1.00/003.0076 from European Regional Development Fund and by the project of Ministry of Health of the Czech Republic for conceptual development of research organization 00064203/6001/02.

Conflict of Interest

The authors declare that they have no conflict of interest

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Authors and Affiliations

  1. Department of Paediatrics and Transplantation Centre, University Hospital Motol–2nd Medical School, Charles University in Prague, Prague, Czech Republic

    Tomáš Rosík, Jiří Dušek, Naděžda Šimánková, Karel Vondrák, Jakub Zieg & Tomáš Seeman

  2. Department of Pathology, University Hospital Motol–2nd Medical School, Charles University in Prague, Prague, Czech Republic

    Mária Chadimová & Jaromír Háček

  3. Biomedical Centre, Faculty of Medicine in Plzen, Charles University in Prague, Prague, Czech Republic

    Tomáš Seeman

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  1. Tomáš Rosík
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Correspondence to Tomáš Rosík or Tomáš Seeman.

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Rosík, T., Chadimová, M., Dušek, J. et al. Proteinuria 1 year after renal transplantation is associated with impaired graft survival in children. Pediatr Nephrol 30, 1853–1860 (2015). https://doi.org/10.1007/s00467-015-3114-6

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  • DOI: https://doi.org/10.1007/s00467-015-3114-6

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