Title: Proteinuria as a Noninvasive Marker for Renal Allograft Histology and Failure: An Observational Cohort Study
Authors: Naesens, Maarten ×
Lerut, Evelyne
Emonds, Marie-Paule
Herelixka, Albert
Evenepoel, Pieter
Claes, Kathleen
Bammens, Bert
Sprangers, Ben
Meijers, Björn
Jochmans, Ina
Monbaliu, Diethard
Pirenne, Jacques
Kuypers, Dirk #
Issue Date: Jan-2016
Publisher: Williams & Wilkins
Series Title: Journal of the American Society of Nephrology vol:27 issue:1 pages:281-292
Article number: ASN.2015010062
Abstract: Proteinuria is routinely measured to assess renal allograft status, but the diagnostic and prognostic values of this measurement for renal transplant pathology and outcome remain unclear. We included 1518 renal allograft recipients in this prospective, observational cohort study. All renal allograft biopsy samples with concomitant data on 24-hour proteinuria were included in the analyses (n=2274). Patients were followed for ≥7 years post-transplantation. Compared with proteinuria <0.3 g/24 h, the hazard ratios for graft failure were 1.14 (95% confidence interval [95% CI], 0.81 to 1.60; P=0.50), for proteinuria 0.3-1.0 g/24 h, 2.17 (95% CI, 1.49 to 3.18; P<0.001), for proteinuria 1.0-3.0 g/24 h, and 3.01 (95% CI, 1.75 to 5.18; P<0.001), for proteinuria >3.0 g/24 h, independent of GFR and allograft histology. The predictive performance of proteinuria for graft failure was lower at 3 months after transplant (area under the receiver-operating characteristic curve [AUC] 0.64, P<0.001) than at 1, 2, and 5 years after transplant (AUC 0.73, 0.71, and 0.77, respectively, all P<0.001). Independent determinants of proteinuria were repeat transplantation, mean arterial pressure, transplant glomerulopathy, microcirculation inflammation, and de novo/recurrent glomerular disease. The discriminatory power of proteinuria for these intragraft injury processes was better in biopsy samples obtained >3 months after transplant (AUC 0.73, P<0.001) than in those obtained earlier (AUC 0.56, P<0.01), with 85% specificity but lower sensitivity (47.8%) for proteinuria >1.0 g/24 h. These data support current clinical guidelines to routinely measure proteinuria after transplant, but illustrate the need for more sensitive biomarkers of allograft injury and prognosis.
ISSN: 1046-6673
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Laboratory of Nephrology
Translational Cell & Tissue Research
Laboratory of Experimental Transplantation
Laboratory of Abdominal Transplantation
× corresponding author
# (joint) last author

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Naesens M et al JASN 2015 - Proteinuria as marker for kidney transplantation.pdf Published 1659KbAdobe PDFView/Open
2015-03-06 proteinuria paper version 11.0 J Am Soc Nephrol_suppl_material.pdfSupplemental Files Published 235KbAdobe PDFView/Open
2015-03-27 proteinuria paper version 11 0 J Am Soc Nephrol_accepted_no_figures.pdf Published 643KbAdobe PDFView/Open

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