THE PROGNOSTIC IMPORTANCE OF POSTTRANSPLANT PROTEINURIA

In this study, we reviewed the records 514 patients, followed-up in our transplantation out-patien clinic from 1983 to 1996 years and significant proteinuria was detected in 107 (63 from living-related, 44 of cadaveric donor origin) of the patients. 56 (11%) patients with good allograft function (serum creatinine level below 2 mg/dl) and proteinuria were evaluated retrospectively in this study. We aimed to investigate the effect of both type and amount of procinuria in order to detect which has more pronounced effect, on allograft survival. The mean time interval between transplantation and the appcarence of proteinuria was 23.7 Months (range 0-121 months). Patients with proteinuria were classified as Group P (patients with persistent proteinuria; including 16 male, 4 female) and Group T (patients with temporary proteinuria; including 29 male and 7 female) according to the type of the proteinuria. Also, considering the amount of the proteinuria , patients were classified as Group M (patients with massive (more than 3.5 gr/24h) proteinuria; including 29 male and 3 female) and Group NM (patients with nonmassive (less than 3.5 gr/24h) proteinuria; including 16 male, 8 female). The amount (massive or nonmassive) and type (temporary or persistent) of proteinuria did not relate with patients' age, donor source and maintenance immunosuppressive therapy. In terms of the time of the appearance oj proteinuria, there was no statistically significant difference between either Group NM or Group P and Group T. 2 and 5-year allograft survival rates were found to be 85% and 80% in Group M and 95% and 82% in Group NM, respectively and no significant difference was noted between groups N and NM (p=0.24). In terms of type of proteinuria, 2 and 5 year allograft survival rates were found to be 70% and 58% in Group P and 92% and 87% in Group T, respectively and difference between groups P and T was found to be statistically significant (p-0.02). In conclusion, we found significant relation between type and severity of proteinuria. Most of the patients with massive proteinuria also had persistent type proteinuria at the same time. Type of the posttransplant proteinuria have stronger effect on allograft outcome than severity of proteinuria.