Perfiles evolutivos de la proteinuria en el trasplante renal: Factores predictivos de su aparición

• Autores: Luis Antonio Jiménez del Cerro, Antonio Franco Esteve, Jesús Olivares Martín
• Localización: Nefrología: publicación oficial de la Sociedad Española de Nefrología, ISSN 0211-6995, Vol. 22, Nº. 4, 2002, págs. 356-363
• Idioma: español
• Títulos paralelos:
  • Profile of proteinuria in the renal transplant recipient: Factors predicting its appearance
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• Resumen
  • español

    La proteinuria es un factor de riesgo que acelera la progresión de la insuficiencia renal. En el trasplante renal la proteinuria se relaciona con una menor supervi- vencia del injerto y del paciente.

    Realizamos un estudio longitudinal caso control, observacional, para evaluar la proteinuria en una serie de 100 trasplantes renales y determinar los diversos fac- tores que influyen en su aparición. Se consideraron múltiples variables excluyen- do para el análisis de los datos a 3 pacientes fallecidos con injerto funcionante.

    La proteinuria en los meses 1, 3, 6, 9 y 12 ha sido: 0,38 ± 0,27 g/día, 0,38 ± 0,32 g/día, 0,44 ± 0,99 g/día, 0,42 ± 0,58 g/día y 0,37 ± 0,54 g/día, respectiva- mente. Analizado cada paciente individualmente, 53 pacientes (54,6%) no desa- rrollaron proteinuria, 12 pacientes (12,4%) tuvieron proteinuria inicial transitoria, 23 pacientes (23,7%) presentaron proteinuria estable persistente y 9 pacientes (9,3%) desarrollaron proteinuria de incremento progresivo. Las cifras de creatini- na más elevadas se evidenciaron en los pacientes con proteinuria estable per- sistente y en aquellos que desarrollaron proteinuria de incremento progresivo.

    En el análisis univariante vemos que la edad del donante es mayor en el grupo de pacientes con proteinuria estable persistente y la incidencia de rechazo agudo es mayor en el grupo de pacientes que desarrollaron proteinuria de incremento progresivo, no existiendo diferencias en las otras variables consideradas.

    El análisis multivariante confirmó que la edad del donante y la enfermedad glo- merular como nefropatía de base, tienen valor predictivo de la proteinuria esta- ble persistente y el rechazo agudo de la aparición de proteinuria de incremento progresivo.

    Concluimos, que la proteinuria es frecuente en la población trasplantada exis- tiendo diversos perfiles evolutivos. Dos tipos están asociados a mala función renal y tienen diferentes factores predictivos. La edad del donante y la enfermedad glo- merular como nefropatía de base predicen la proteinuria estable persistente y el rechazo agudo la proteinuria de incremento progresivo

  • English

    Proteinuria is a risks factor that accelerates the progression of renal insufficiency by several mechanisms. In the renal transplant proteinutia is a predictor of pro- gressive renal insufficiency and it is associated with poor patient and graft survi- val.

    We have performed a longitudinal observational case-control study to defect and quantify proteinuria in a group of 100 cadaveric renal transplant recipients and to evaluate the influence of several factors on its appearance.

    We have considered the variables age and sex of the donor and recipient, num- ber of HLA-DR, A and B mismatches, cold ischemia time, basal renal disease, ini- tial immunosuppression, immediate versus delayed graft function and acute re- jection. Three patients who did with a functioning graft were excluded from the analysis of the data. All variables were analysed in a regression model of multi- variate analysis.

    Proteinuria in the moths 1, 3, 6, 9 and 12 was: 0.38 ± 0.27 g/day, 0.38 ± 0.32 g/day, 0.44 ± 0.99 g/day, 0.42 ± 0.58 g/day and 0.37 ± 0.54 g/day, respectively.

    We analysed the profile of the proteinuria in each patient individually. Fifty three patients (54.6%) did not develop proteinuria, 12 patientes (12.4%) had transient initial proteinuria, 23 patients (23.7%) had persistent proteinuria and 9 patients (9.3%) had progressive proteinuria.

    The renal function differed between groups. Higher creatinine leves were found in the patients with persistent proteinuria and those with progressive proteinuria.

    We analysed the patients according to several variables. The age of the donor was higher in the group of patients with persistent proteinuria and the incidence of acute rejection was higher in the group of patients who developed progressi- ve proteinuria, with differences statistically significant. There was no difference in the univariate analysis in the other variables considerated.

    The multivariate analysis confirms that the age of the donor and the basal glo- merular disease predict persistent proteinuria and acute rejection predicts pro- gressive proteinuria.

    According to our study, proteinuria is frequent in the renal transplant recipient with different evolutionary profiles. Two types are associated with bad renal func- tion and have different predictive factors. We encourage the use of drugs which reduce proteinuria.