Proteinuria after conversion to sirolimus in kidney transplant recipients: impact of pre-existing proteinuria, graft function, and angiotensin-converting enzyme inhibitors/angiotensin-receptor antagonists

Clinical Transplantation
Christian MarxGunter Wolf

Abstract

Proteinuria is a known side effect of therapy with sirolimus. The effect of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEI/ARB ) on sirolimus-associated proteinuria has not yet been assessed. A retrospective cohort study of renal transplant patients treated with sirolimus (n = 55) was performed. Of 55 patients, 24 (44%) had no proteinuria (<0.15 g/d) prior to conversion. Of 24 patients, 11 (46%) showed de novo proteinuria >0.15 g/d after 12 months, only 2 developed proteinuria > 1 g/d. The total number of proteinuria >1 g/d after 12 months including patients with pre-existing proteinuria >1 g/d (n = 3) was seven of 55 patients (13%). Multivariate regression analysis revealed pre-existing proteinuria > 0.15 g/d and reduced glomerular filtration rate as independent predictors for the development of proteinuria after conversion to sirolimus. Reduced glomerular filtration rate and pre-existing proteinuria but not therapy with ACEI/ARB are independent predictors for proteinuria after conversion to sirolimus. Treatment with ACEI/ARB did not reduce pre-existing proteinuria after conversion except in single cases with severe proteinuria.

References

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Citations

Mar 22, 2012·Experimental and Clinical Transplantation : Official Journal of the Middle East Society for Organ Transplantation·Cyril GarrousteLionel Rostaing
Jul 16, 2015·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·D A MandelbrotS L Schulman
Dec 19, 2014·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·K BuddeUNKNOWN ZEUS Study Investigators
Sep 4, 2015·Transplantation·Anne Tsampalieros, Greg A Knoll

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