Publications (2)3.4 Total impact
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ABSTRACT: Proteinuria is considered one of the most important prognostic markers of chronic kidney disease progression in native kidneys. In renal-transplanted population, proteinuria presents a high prevalence because early stages and its presence, in higher or lower degrees, have been related to the lower graft survival and a higher risk of death, mainly because of cardiovascular diseases, in renal transplantation. Although there is a good correlation between higher degree proteinuria and histologic findings, histology is not very useful in the study of lower degree proteinuria. In that case, the knowledge of different types of proteins present in urine could be useful to know which type of damage underlies on the graft. Proteomics and different laboratory techniques could be helpful to identify damage markers on different conditions, especially on tubulointerstitial damage, that should have a subtle clinical presentation. Diagnosis of proteinuria in renal transplantation follows the same criteria of general population, actually, and in the last years, some authors have tried to achieve the usefulness of different diagnostic methods such as protein/creatinine ratio or albumin/creatinine ratio in the renal-transplanted population in comparison with 24-hour collected urine diagnostic techniques. Nevertheless, there are no studies about the limit to be considered as "normal" in this population, which shows a reduced nephron mass and a higher risk of developing proteinuria. Recent literature about the prognostic significance of lower degrees of proteinuria on graft and patient survival in this population could be the proof that new studies are needed to establish the normal threshold of proteinuria to be considered in kidney transplantation.Transplantation reviews (Orlando, Fla.) 01/2012; 26(1):30-5.
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ABSTRACT: Acute rejection episodes are a major determinant of renal allograft survival, and the improvement of the transplantation results in the last two decades is largely due to a progressive decrease in the incidence of acute rejection. These results are explained by the incorporation of new immunosuppressive agents since the introduction of cyclosporine. Because the detrimental effect of acute rejection on graft survival is not limited to the early post-transplant period, we have focused on the impact of acute rejection episodes on late transplant failure in patients with the graft functioning 1 year after transplantation. We have retrospectively analysed in 3365 renal transplants performed in adults in Spain during 1990, 1994 and 1998 the incidence and severity of the acute rejection episodes, their risk factors, and their influence on graft and patient survival. The incidence of rejection episodes in the whole series was 32.5%, decreasing in 1998 (25.1%) compared with the previous years (38%) (P<0.0001). Corticoid-resistant rejection episodes also decreased from 8% in 1990 and 1994 to 3.4% in 1998 (P<0.0001). Multivariate analysis showed that patients < 60 years old (P<0.0001), sensitized recipients (P = 0.038), patients with delayed graft function (P<0.0001), cytomegalovirus infection (P = 0.0060), and those transplanted in 1990 or 1994 (P<0.0001) had an increased incidence of rejection episodes. In the univariate analysis, induction treatment with antilymphocyte globulines or OKT3 (P = 0.0002), and traumatic donor death (P = 0.042) were associated with a lower incidence of acute rejection. In the univariate analysis of the transplants performed in 1998, addressed to evaluate the effect of the new immunosuppressive agents, treatment with mycophenolate mofetil (P<0.0001) or tacrolimus (P = 0.0067), but not with anti-IL2 antibodies reduced the incidence of acute rejection. Patients with rejection episodes had an increased risk of late graft failure (Cox proportional hazards model, P<0.0001), which was homogeneous in the three periods analysed, with no effect on patient survival (P = 0.13). Despite a decreased incidence and severity of acute rejections in 1998, compared with the previous years, acute rejection still remains a powerful risk factor for late transplant failure.Nephrology Dialysis Transplantation 06/2004; 19 Suppl 3:iii38-42. · 3.40 Impact Factor