Proteinuria is highly prevalent in renal transplantation, but there is no information about the relationship between changes in proteinuria in early stages of transplantation and long term prognosis.

AIMS

To analyze the effect of the magnitude of proteinuria and its relative changes from 3rd to 12th month after transplantation on long term graf and patient survival.

METHODS

Retrospective analysis of 701 kidney transplants performed in our unit from deceased donors. Baseline proteinuria (3rd month) and proteinuria at 12th month after transplantation in 24h urine were analyzed. Proteinuria was categorized depending on its magnitude: (0)0-149mg/d, (1)150-299mg/d, (2)300-999mg/d y (3)>=1g/d and the relative changes of proteinuria from 3rd to 12th month was calculated and categorized: (0)reduction <= 50%, (1)increase or decrease (Δ) <50%, and (2)increase >= 50% from baseline. Associations between baseline and 12th months and changes of proteinuria were examined using Kaplan-Meier and Cox analysis, Χ2 and T-test to analyze differences between groups.

RESULTS

593 patients, mean follow-up of 84.5±48.6 months (range: 12.1-191.6). Proteinuria >= 150mg/d was present in 49.9% at 3rd and 47.0% at 12th month. Increasing degrees of proteinuria at 3rd and 12th month were associated with long term graft failure (P=0.000) and mortality in 12th months (P=0.000). We observed an increasing relative risk of graft failure and mortality from category 2 at 3rd (HR 2.083, 95%CI: 1.362-3.187, P=0.001) and 12th month (HR 3.051, 95%CI: 1.966-4.733P=0.000) that increases in category 3 (p=0.000).

Between 3rd and 12th month we observed a decrease of proteinuria <=50% in 35.1%, Δ<50% in 41% and increase >= 50% in 23.8% of patients. Progression >= 50% was associated with graft failure (P= 0.000) and mortality (P=0.017) in every category of baseline proteinuria analyzed (P=0.000). Progression >=50% was an independent risk factor of graf failure (HR 3.152,P= 0.000) and mortality (HR:2.858,P= 0.027). Proteinuria progression >=50% was only related to postransplant HLA sensitization (P=0.027).

CONCLUSIONS

Risk of graft failure and mortality increases with increasing amounts of proteinuria and with time from transplantation, since early stages of kidney transplant. Proteinuria progression >= 50% from 3rd to 12th month was an independent risk factor of graft failure and mortality, regardless of baseline proteinuria category.

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