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• W1989939251 abstract "86 In patients with nephrotic syndrome due to disease of native kidneys, it has been suggested that the degree of proteinuria predicts rapidity of progression to ESRD, and may be etiologic in continuing renal damage, once the initial insult has occurred. Patients with chronic rejection develop proteinuria early in the course of the disease, but the degree of proteinuria has not been correlated with time to ESRD. We studied 61 non-diabetic cyclosporine-treated renal transplant recipients who had creatinine values less than 2.5 mg/dl at the time of 24-hour urine for protein and creatinine and iothalamate GFR measurements during the years 1993 and 1994. During the 4-year follow-up period, 23 patients suffered graft loss (38%). There was no difference between patients who kept their grafts (NOFAIL) and those who did not (FAIL) as regards age (45.9±2.0 vs. 44.5±2.2 yrs), BP (142±4.0/90.4±2.2 vs. 147.2±95.6±2.5 mmHg), cholesterol (295.5±7.1 vs. 308.0±10.0 mg/dl), LDL, HDL or triglycerides at the time of the 24 hour urine and GFR measurements. The race and gender distributions were also similar. The initial GFR was 48.5±4.2 in the NOFAIL group and 39.1±3.1 ml/min in the FAIL group (p=NS), with mean concomitant creatinines of 1.83±0.3 vs. 2.04±0.3 mg/dl. At initial measurement, urine protein was significantly higher in the FAIL group (831.4±303.4 vs. 207.5±22.0 mg/24 hours, p < 0.05, by independent sample t-test). By Cox proportional hazard analysis time to graft failure for the group as a whole was significantly related to amount of proteinuria (RR = 1.0004, p < 0.05) as was overall risk of graft failure (RR = 1.0009, p < 0.0005) but neither related to concomitantly measured GFR or creatinine. Proteinuria > 1 gm at the time of GFR measurement increased the relative risk of graft loss over the observation period to 5.4 (p=0.0009), independent of time since transplant (p=NS). In conclusion, in a population of non-diabetic patients, with initial excellent kidney function: 1)Patients who lost their grafts did not differ from those who maintained graft function as far as lipid profile, hypertension, gender, race or age. 2) Degree of proteinuria predicted time to graft failure, independent of creatinine or GFR at the time of measurement, and thus did not appear to be simply a marker of poorer kidney function; 3)Proteinuria greater than 1 gram increased risk of graft loss 5-fold over the ensuing 4 year follow-up; 4) The possibility that proteinuria per se is injurious to the kidney should be entertained. Proteinuric transplant patients may benefit from treatment with ACE inhibitors or angiotensin-receptor blocking agents as is the recommendation for patients with proteinuric disease of their native kidneys, in order to offset the potentially deleterious effects of protein trafficking on the transplanted kidney." @default.
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• W1989939251 date "1999-04-01" @default.
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• W1989939251 title "DEGREE OF PROTEINURIA PREDICTS RAPIDITY OF PROGRESSION OF CHRONIC REJECTION TO END-STAGE RENAL DISEASE (ESRD) AND RISK OF GRAFT LOSS IN PATIENTS WITH EXCELLENT KIDNEY FUNCTION INDEPENDENT OF RENAL FUNCTION AT THE TIME OF MEASUREMENT" @default.
• W1989939251 doi "https://doi.org/10.1097/00007890-199904150-00114" @default.
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