What is the significance of proteinuria in kidney transplant recipients?
In patients who have received kidney transplant, proteinuria occurs in up to 45% of cases. It is associated with CVD events and mortality. A baseline level of urine protein should be obtained in the first month post transplantation, every 3 months in the first year post transplantation, and then annually. It is important to note the patient’s urine output prior to transplant, as diseased native kidneys can be a cause of posttransplant proteinuria. Persistent proteinuria not from the native kidneys is a sign of allograft pathology, including transplant glomerulopathy, interstitial fibrosis and tubular atrophy, de novo or recurrence of a primary nephrotic disease, and rejection. Mammalian target of rapamycin (mTOR) inhibitors may cause proteinuria. The gold standard for diagnosing the cause of the proteinuria is kidney transplant biopsy. In regards to treatment, RAAS blockade should be considered to reduce proteinuria.
