Rosík Tomáš, Chadimová Mária, Dušek Jiří, Háček Jaromír, Šimánková Naděžda, Vondrák Karel, Zieg Jakub, Seeman Tomáš
Department of Paediatrics and Transplantation Centre, University Hospital Motol-2nd Medical School, Charles University in Prague, Prague, Czech Republic,
Pediatr Nephrol. 2015 Oct;30(10):1853-60. doi: 10.1007/s00467-015-3114-6. Epub 2015 Apr 30.
Proteinuria is a common manifestation of chronic kidney disease (CKD), and there is a high incidence of CDK and its complications following renal transplantation. However, little data are available on the association between proteinuria and graft/patient survival in the paediatric transplant population. The primary aim of this study was to investigate the associations between posttransplant proteinuria and graft/patient survival in children after renal transplantation.
In this retrospective study, we screened all 91 children receiving renal allografts at a single institution between 1997 and 2007. The inclusion criteria were a functioning graft at 1 year posttransplant, data availability and no recurrence of focal-segmental glomerulosclerosis. The final cohort included 75 patients. Proteinuria was considered to be pathologic if the urinary protein/creatinine ratio was >30 mg/mmol. Donor and recipient characteristics, data on proteinuria, estimated glomerular filtration rate (eGFR) and rejection episodes were analysed. The most recent of the biopsies performed during the follow-up after 1 year posttransplant were analysed separately in the proteinuric group and the non-proteinuric group.
Proteinuria at 1-year posttransplant was pathologic in 35 % of patients. The 5-year graft survival rate was significantly lower in the proteinuric group than in the non-proteinuric group (77 vs. 100 %; p < 0.001). Proteinuria at 1 year posttransplant was associated with reduced long-term graft survival independent of other risk factors, including decreased eGFR or episodes of acute corticosensitive and corticoresistant rejection. The most frequent histologic finding in the proteinuric group was chronic rejection. There was no significant difference in the 5-year patient survival rate between the proteinuric group and the non-proteinuric group.
This study emphasizes the importance of proteinuria as a prognostic factor of renal allograft survival in children.
蛋白尿是慢性肾脏病（CKD）的常见表现，肾移植后慢性肾脏病（CDK）及其并发症的发生率很高。然而，关于小儿移植人群中蛋白尿与移植物/患者生存之间的关联，现有数据很少。本研究的主要目的是调查肾移植后儿童移植后蛋白尿与移植物/患者生存之间的关联。
在这项回顾性研究中，我们筛选了1997年至2007年间在单一机构接受同种异体肾移植的所有91名儿童。纳入标准为移植后1年移植物功能正常、数据可用且无局灶节段性肾小球硬化复发。最终队列包括75名患者。如果尿蛋白/肌酐比值>30mg/mmol，则认为蛋白尿为病理性。分析了供体和受体特征、蛋白尿数据、估计肾小球滤过率（eGFR）和排斥反应发作情况。对移植后1年随访期间进行的活检中最新的活检结果，在蛋白尿组和非蛋白尿组中分别进行分析。
移植后1年时，35%的患者出现病理性蛋白尿。蛋白尿组的5年移植物存活率显著低于非蛋白尿组（77%对100%；p<0.001）。移植后1年的蛋白尿与长期移植物存活率降低相关，与其他风险因素无关，包括eGFR降低或急性皮质敏感和皮质抵抗性排斥反应发作。蛋白尿组最常见的组织学发现是慢性排斥反应。蛋白尿组和非蛋白尿组的5年患者存活率无显著差异。
本研究强调了蛋白尿作为儿童肾移植移植物存活预后因素的重要性。
