Hamdy Ahmed F, Bakr Mohamed A, Ghoneim Mohamed A
Urology and Nephrology Center, Mansoura University, Egypt.
Exp Clin Transplant. 2010 Dec;8(4):283-91.
Recent evidence of a high incidence of proteinuria among de novo sirolimus-based regimens has been reported among renal transplant patients at short-term follow-up. We report on long-term evaluation of proteinuria among patients maintained on such regimen.
Between May 2001 and January 2003, 132 patients received a renal allograft from a living donor and were randomized to 2 groups (steroids/sirolimus/tacrolimus, n=65) and (steroids/sirolimus/mycophenolate mofetil, n=67): Both received basiliximab induction. Retrospective review of those patients was performed, 5 years posttransplant with particular emphasis on the incidence of proteinuria.
The 5-year incidence of proteinuria was 29.2% and 38.8% among sirolimus/tacrolimus and sirolimus/mycophenolate mofetil group. Single DR-matched patients (P = .016) and the incidence of acute rejection (P = .039) were associated with significantly higher incidence of proteinuria. Moreover, the presence of mesangial matrix increased (P = .015), and glomerulosclerosis (P = .014), in 1-year protocol biopsies, was found to have a positive predictive value for current and future incidences of proteinuria. Proteinuria was found to be associated with significant inferior graft outcome. Recurrent original kidney disease, de novo glomerulopathy, and acute transplant glomerulopathy were responsible for early cases of nephrotic range proteinuria (first 2 years), while cases presented later were attributed to chronic allograft nephropathy.
Proteinuria has become a recognized, serious event of primarily sirolimus-treated renal transplants patients, which is most probably of glomerular origin. It has been shown that proteinuria exerts a bad prognostic effect upon graft function and subsequent graft survival at 5-year follow-up.
近期有报道称，在肾移植患者短期随访中，基于西罗莫司的初始治疗方案中蛋白尿发生率较高。我们报告了接受此类治疗方案的患者蛋白尿的长期评估情况。
2001年5月至2003年1月期间，132例患者接受了活体供肾移植，并被随机分为两组（类固醇/西罗莫司/他克莫司，n = 65）和（类固醇/西罗莫司/霉酚酸酯，n = 67）：两组均接受巴利昔单抗诱导治疗。对这些患者进行了移植后5年的回顾性研究，特别关注蛋白尿的发生率。
西罗莫司/他克莫司组和西罗莫司/霉酚酸酯组的5年蛋白尿发生率分别为29.2%和38.8%。单倍型DR匹配患者（P = 0.016）和急性排斥反应发生率（P = 0.039）与蛋白尿发生率显著升高相关。此外，在1年的方案活检中发现，系膜基质增加（P = 0.015）和肾小球硬化（P = 0.014）对当前和未来蛋白尿的发生率具有阳性预测价值。蛋白尿与显著较差的移植肾结局相关。复发性原肾疾病、新发肾小球病和急性移植肾小球病是早期肾病范围蛋白尿（前2年）的原因，而后期出现的病例则归因于慢性移植肾肾病。
蛋白尿已成为主要接受西罗莫司治疗的肾移植患者中一种公认的严重事件，其最可能起源于肾小球。研究表明，蛋白尿在5年随访中对移植肾功能和随后的移植肾存活具有不良预后影响。
