Proteinuria after kidney transplantation, relationship to allograft histology and survival
Proteinuria after kidney transplantation, relationship to allograft histology and survival
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DOI：
10.1111/j.1600-6143.2007.02006.x
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发表时间：
2007-12-01
影响因子：
8.8
通讯作者：
Cosio, F. G.
中科院分区：
文献类型：
--
作者：
Amer, H.;Fidler, M. E.;Cosio, F. G.
蛋白尿与肾同种异体移植物存活率降低有关。在此，我们评估了蛋白尿、移植物组织学和生存之间的关联。该队列包括 613 名同种异体肾移植受者，他们在移植后 1 年有蛋白尿（测量）和监测活检。 276 名患者 (45%) 检测到蛋白尿 > 150 毫克/天，其中 182 名患者的蛋白尿低于 500。在 > 84% 的患者中，即使低水平的蛋白尿也与白蛋白尿相关。蛋白尿与移植肾小球病理的存在和西罗莫司的使用有关。百分之八十的蛋白尿> 1500 mg/天的患者在活检时有肾小球病理改变。然而，较低水平的蛋白尿与 1 年时的特定病理情况无关。与不使用西罗莫司相比，使用西罗莫司与较高的蛋白尿发生率（40% vs. 76%，p < 0.0001）和较高的蛋白质排泄（378 + 997 vs. 955 + 1986 mg/天，p < 0.0001）相关。蛋白尿与移植物存活率降低相关（HR = 1.40，p = 0.001），独立于其他危险因素，包括肾小球病理、移植物功能、受体年龄和急性排斥反应。丢失同种异体移植物 (n = 57) 的主要病理是肾小球，特别是在 1 年蛋白尿 > 500 的患者中。因此，45% 的受者在 1 年时出现蛋白尿，通常水平较低（< 500 mg/天）。然而，即使是低水平的蛋白尿也与移植物存活率差有关。蛋白尿和肾小球病理学与生存独立相关。
Proteinuria is associated with reduced kidney allograft survival. Herein we assessed the association between proteinuria, graft histology and survival. The cohort included 613 kidney allograft recipients who had proteinuria (measured) and surveillance biopsies at 1-year posttransplant. Proteinuria > 150 mg/day was detected in 276 patients (45%) and in 182 of these, proteinuria was below 500. In > 84% of patients even low levels of proteinuria were associated with albuminuria. Proteinuria was associated with the presence of graft glomerular pathology and the use of sirolimus. Eighty percent of patients with proteinuria > 1500 mg/day had glomerular pathology on biopsy. However, lower levels of proteinuria were not associated with specific pathologies at 1 year. Compared to no sirolimus, sirolimus use was associated with higher prevalence of proteinuria (40% vs. 76%, p < 0.0001) and higher protein excretion (378 + 997 vs. 955 + 1986 mg/day, p < 0.0001). Proteinuria was associated with reduced graft survival (HR = 1.40, p = 0.001) independent of other risk factors including, glomerular pathology, graft function, recipient age and acute rejection. The predominant pathology in lost allografts (n = 57) was glomerular, particularly in patients with 1-year proteinuria > 500. Thus, proteinuria, usually at low levels (< 500 mg/day), is present in 45% of recipients at 1 year. However, and even low levels of proteinuria relate to poor graft survival. Proteinuria and glomerular pathology relate independently to survival.