PMID- 25159718
OWN - NLM
STAT- MEDLINE
DCOM- 20160113
LR  - 20171010
IS  - 1432-198X (Electronic)
IS  - 0931-041X (Linking)
VI  - 30
IP  - 6
DP  - 2015 Jun
TI  - Management of proteinuria in the transplanted patient.
PG  - 889-903
LID - 10.1007/s00467-014-2876-6 [doi]
AB  - Proteinuria is a relatively frequent complication in children after renal
      transplantation (40-80 %). It is usually mild and non-nephrotic in nature and
      predominantly tubular in origin. The major causes of post-transplant proteinuria 
      are recurrence of primary glomerulonephritis [mostly focal segmental
      glomerulosclerosis (FSGS)], rejection (acute and chronic), mTOR inhibitors or
      hypertension. Proteinuria is a risk factor for graft loss and patient death in
      adults, and even a mild proteinuria (0.1-0.2 g/day) is associated with impaired
      graft and patient survival. In children, proteinuria seems to be associated with 
      graft but not patient survival. Proteinuria (protein/creatinine ratio) should be 
      assessed regularly in all children. In children with prior chronic kidney disease
      due to idiopathic FSGS, proteinuria should be assessed daily during the first
      month after transplantation to enable early diagnosis of recurrence. The cause of
      proteinuria should be identified, and graft biopsy should be considered in
      children with unexplained proteinuria, especially with new onset proteinuria or
      deterioration of previously mild proteinuria. Treatment must be primarily
      targeted at the cause of proteinuria, and in normotensive children symptomatic
      antiproteinuric therapy with angiotensin-converting enzyme inhibitors/angiotensin
      II receptor antagonists should also be initiated. Other antihypertensive drugs
      should be used to achieve target blood pressure of <75th percentile. Target
      proteinuria should be <20 mg/mmol creatinine.
FAU - Seeman, Tomas
AU  - Seeman T
AD  - Department of Pediatrics and Transplantation Center, 2nd Faculty of
      Medicine-University Hospital Motol, Charles University in Prague, V Uvalu 84,
      15006, Prague, Czech Republic, tomas.seeman@lfmotol.cuni.cz.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20140827
PL  - Germany
TA  - Pediatr Nephrol
JT  - Pediatric nephrology (Berlin, Germany)
JID - 8708728
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Immunosuppressive Agents)
RN  - EC 2.7.1.1 (MTOR protein, human)
RN  - EC 2.7.1.1 (TOR Serine-Threonine Kinases)
SB  - IM
MH  - Age Factors
MH  - Angiotensin Receptor Antagonists/therapeutic use
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Antihypertensive Agents/therapeutic use
MH  - Glomerulosclerosis, Focal Segmental/complications/diagnosis
MH  - Graft Rejection/diagnosis/etiology/therapy
MH  - Graft Survival
MH  - Humans
MH  - Hypertension/complications/diagnosis/drug therapy
MH  - Immunosuppressive Agents/adverse effects
MH  - Kidney Failure, Chronic/diagnosis/etiology/*surgery
MH  - Kidney Transplantation/*adverse effects
MH  - Proteinuria/diagnosis/etiology/physiopathology/*therapy
MH  - Recurrence
MH  - Renin-Angiotensin System/drug effects
MH  - Risk Factors
MH  - TOR Serine-Threonine Kinases/antagonists & inhibitors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2014/08/28 06:00
MHDA- 2016/01/14 06:00
CRDT- 2014/08/28 06:00
PHST- 2014/02/03 00:00 [received]
PHST- 2014/06/03 00:00 [accepted]
PHST- 2014/05/23 00:00 [revised]
PHST- 2014/08/28 06:00 [entrez]
PHST- 2014/08/28 06:00 [pubmed]
PHST- 2016/01/14 06:00 [medline]
AID - 10.1007/s00467-014-2876-6 [doi]
PST - ppublish
SO  - Pediatr Nephrol. 2015 Jun;30(6):889-903. doi: 10.1007/s00467-014-2876-6. Epub
      2014 Aug 27.