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Abstract: FR-PO1178

Proteinuria in Children and Adolescents Following Renal Transplantation: Results from the Cooperative European Pediatric Renal Transplant Initiative (CERTAIN)

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Büscher, Anja K., University Children's Hospital, Essen, Germany
  • Bernard, Daniel, University Children's Hospital, Essen, Germany
  • Stopfkuchen, Henrike, University Children's Hospital, Essen, Germany
  • Büscher, Rainer, University Children's Hospital, Essen, Germany
  • Hoyer, Peter F., University Children's Hospital, Essen, Germany
  • Seeman, Tomas, University Children's Hospital Motol, Prague, Czechia
  • Krupka, Kai, University Children's Hospital, Heidelberg, Germany
  • Toenshoff, Burkhard, University Children's Hospital, Heidelberg, Germany

Group or Team Name

  • Members of the CERTAIN registry study group
Background

Proteinuria is a major risk factor for the progression of chronic kidney disease and - in patients after renal transplantation (RTx) - associated with higher mortality and an increased risk of graft failure. Pediatric studies are rare, often limited due to small patient numbers and present heterogenous results regarding prevalence and outcome.

Methods

Data of 195 children (mean age at RTx 10.6±5.2 years, 60% male) from the CERTAIN registry was analyzed 3 months, 1 and 3 ys post RTx. Prevalence, quantity and quality of proteinuria was correlated with GFR and potential influencing factors were evaluated (underlying disease, BMI, dialysis, HLA-mismatch, cold ischemia time, immunosuppression (IS), BKV infection).

Results

77% of patients developed proteinuria >200mg/g creatinine (crea) within 3 months post RTx, 9% of these > 1000mg/g crea; Proteinuria was of glomerular origin in 71% and decreased by 40% within 3 ys. Increasing proteinuria was negatively correlated with GFR especially in the long-term follow-up (p=0.004, 3ys post RTx). Patients with glomerulopathies had significantly higher proteinuria (p<0.001) after 3ys post RTx. BMI SDS was positively correlated with proteinuria (p<0.03) at time of RTx, but this effect did not persist over time. Cold ischemia time was correlated with the extent of proteinuria (p=0.01) as well as the number of HLA mismatches. Patients with BKV infection developed proteinuria in 52% (with higher urinary protein excretion compared to BKV negative patients (p<0.001). The mode of dialysis and the type of IS did not influence proteinuria significantly, but we detected slightly higher levels of urinary protein in patients with a history of peritoneal dialysis and in mTOR inhibitor-based IS, respectively. Proteinuria did not correlate with hypertension, duration of dialysis, CMV/EBV or urinary tract infections.

Conclusion

The majority of pediatric patients developed proteinuria following RTx, Although proteinuria was of only mild to moderate extent in most patients and decreased over time, it was significantly correlated with a reduction of GFR. Proteinuria was associated with several risk factors with the highest impact for a prolonged cold ischemia time, high number of HLA mismatches and BKV infection.

Funding

  • Clinical Revenue Support