Milestones in Transplantation
Kidney transplantation
Renal Doppler Resistance Indices in Kidney Transplant Recipients With Proteinuria

https://doi.org/10.1016/j.transproceed.2018.02.064Get rights and content

Highlights

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    Proteinuria may be a reliable predictor of kidney allograft outcome.

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    Factors such as the resistive index, pulsatility index, serum creatinine level, use of cadaver donors, and graft survival rate affect proteinuria in renal transplant recipients.

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    Regular monitoring of proteinuria and the correlation between the Doppler ultrasound resistive and pulsatility indices should be performed at follow-up visits of kidney transplant recipients.

Abstract

Background

The onset of proteinuria in renal transplant recipients may be associated with an increased risk of allograft failure. Little is known about the relationships between factors influencing proteinuria and the Doppler ultrasound (DU) intrarenal resistive index (RI) and pulsatility index (PI) among donor recipients with proteinuria <1000 mg/24 h.

Methods

We assessed correlations between the DU RI and PI and protein content in 93 selected renal transplant recipients: 62 patients with proteinuria 100 to 299 mg/24 h, 16 patients with proteinuria 300 to 499 mg/24 h, and 15 patients with proteinuria 500 to 999 mg/24 h. All patients underwent transplantation in a single center and were monitored by DU for at least 28 months post-transplantation.

Results

The DU RI values of the proteinuria 100 to 299 mg/24 h, 300 to 499 mg/24 h, and 500 to 999 mg/24 h groups were 0.67 ± 0.05; 0.65 ± 0.04, and 0.64 ± 0.07, respectively, and the PI values were 1.21 ± 0.20, 1.10 ± 0.14, and 1.15 ± 0.22, respectively. Multivariate logistic regression analysis revealed a correlation between group 100 to 299 mg/24 h and RI values, serum creatinine, living donor (R2 = 19.6%, P = .05); group 300 to 499 mg/24 h and the RI, PI values, cadaver donor (R2 = 17.5%, P = .001); and group 500 to 999 mg/24 h and the RI, PI values, serum creatinine, graft survival (R2 = 15.4%, P = .005).

Conclusions

Among donor recipients with proteinuria <1000 mg/24 h, DU RI values were <0.72 and PI values were <1.41 and correlations were revealed between the incidence of proteinuria and factors such as the RI, PI, and serum creatinine level.

Section snippets

Patient Selection

A total of 93 selected renal transplant recipients with proteinuria, who underwent transplantation at a single center, were divided into 3 groups according to the degree of proteinuria: 62 patients (65.5%; 32 male and 30 female subjects, 58 living donors) had proteinuria of 100 to 299 mg/24 h (100–299 mg/24 h group), 16 patients (17.2%; 8 male and 8 female subjects, 10 living donors) had proteinuria of 300 to 499 mg/24 h (300–499 mg/24 h group), and 15 patients (16.1%; 9 male and 6 female

Demographic Data

The demographics and laboratory data of the 93 kidney transplant recipients, by proteinuria group, are listed in Table 1. In the group with proteinuria 100 to 299 mg/24 h, 26 patients (43.5%) received TAC, 9 (14.5%) received CyA, and 26 (43.5%) received SRL. In the group with proteinuria 300 to 499 mg/24 h, 9 patients (56.2%) received TAC, 1 patient (0.6%) received CyA, and 6 patients (37.5%) received SRL. In the group with proteinuria 500 to 999 mg/24 h, 7 patients (46.6%) received TAC, 7

Discussion

Although post-transplant proteinuria has been neglected in kidney transplantation, there is evidence that proteinuria is the main factor predicting graft loss [7]. Nankivell et al demonstrated vasculopathy, interstitial fibrosis, and glomerulosclerosis in a serial protocol of kidney allograft biopsies due to the effects of CNIs [8], [9]. Although the pathologic lesions related to CNI toxicity have been well described, it is probable that not all CNIs are alike. For example, CyA-based

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