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.

Department of Pediatrics and Transplantation Center 2nd Faculty of Medicine University Hospital Motol Charles University Prague 5 Úvalu 84 15006 Prague Czech Republic

Zobrazit více v PubMed

Transplantation. 2001 Aug 15;72(3):438-44 PubMed

Pediatr Transplant. 2007 Aug;11(5):491-7 PubMed

Transplantation. 1999 Feb 27;67(4):561-8 PubMed

Pediatr Transplant. 2006 Dec;10(8):957-61 PubMed

Clin Chem. 1981 May;27(5):709-13 PubMed

Pediatrics. 2000 Jun;105(6):1242-9 PubMed

J Hypertens. 2009 Sep;27(9):1719-42 PubMed

Transplant Rev (Orlando). 2012 Jan;26(1):27-9 PubMed

Pediatr Nephrol. 1998 Sep;12(7):529-33 PubMed

Pediatr Nephrol. 2009 May;24(5):959-72 PubMed

Pediatr Transplant. 2010 Mar;14(2):283-7 PubMed

Kidney Int. 2004 Jun;65(6):2360-70 PubMed

Nefrologia. 2011;31(4):404-14 PubMed

Am J Transplant. 2006 Jul;6(7):1660-5 PubMed

Am J Transplant. 2007 Dec;7(12):2775-81 PubMed

Kidney Blood Press Res. 2009;32(6):440-4 PubMed

Pol Merkur Lekarski. 2000 Apr;8(46):282-3 PubMed

J Am Soc Nephrol. 2013 Nov;24(11):1863-71 PubMed

Pediatr Transplant. 2005 Apr;9(2):226-31 PubMed

Am J Transplant. 2005 Sep;5(9):2281-8 PubMed

Transplantation. 2010 Jan 27;89(2):200-7 PubMed

Nephrol Dial Transplant. 2000 Jan;15(1):82-6 PubMed

Transplant Proc. 2005 Dec;37(10):4282-3 PubMed

Curr Hypertens Rep. 2004 Oct;6(5):383-92 PubMed

Pediatr Nephrol. 2009 Dec;24(12):2439-44 PubMed

Transplantation. 1984 Dec;38(6):607-12 PubMed

Transplant Proc. 1988 Dec;20(6):1235-6 PubMed

Transplant Proc. 2007 Sep;39(7):2145-7 PubMed

Clin Nephrol. 1986 Jul;26(1):1-6 PubMed

Transplant Proc. 1997 Feb-Mar;29(1-2):101-3 PubMed

Nephrol Dial Transplant. 2010 Apr;25(4):1300-6 PubMed

Nephrol Dial Transplant. 2004 Feb;19(2):301-5 PubMed

Transplantation. 2004 Jul 27;78(2):269-75 PubMed

J Korean Med Sci. 2009 Jan;24 Suppl:S129-34 PubMed

Transplantation. 2009 Apr 27;87(8):1232-9 PubMed

Transplantation. 1990 Jan;49(1):35-41 PubMed

Pediatr Nephrol. 2004 Feb;19(2):222-6 PubMed

Lancet. 1997 Apr 19;349(9059):1117-23 PubMed

J Am Soc Nephrol. 2009 Dec;20(12):2490-2 PubMed

Transplantation. 2004 Nov 15;78(9):1362-6 PubMed

J Am Soc Nephrol. 2003 Oct;14(10):2436-46 PubMed

Transplantation. 2000 Oct 27;70(8):1154-9 PubMed

Transplant Proc. 2007 Dec;39(10):3150-2 PubMed

J Am Soc Nephrol. 2011 Mar;22(3):579-85 PubMed

Transplantation. 2007 Jul 15;84(1):104-12 PubMed

N Engl J Med. 2009 Oct 22;361(17):1639-50 PubMed

Am J Transplant. 2004 Nov;4(11):1869-75 PubMed

J Am Soc Nephrol. 2006 Nov;17(11):2974-84 PubMed

Transplant Proc. 2006 Sep;38(7):2319-20 PubMed

Clin J Am Soc Nephrol. 2009 Apr;4(4):812-9 PubMed

Nephron. 1997;75(2):160-5 PubMed

Transplant Proc. 2006 Mar;38(2):463-5 PubMed

Transplantation. 2004 Sep 15;78(5):719-24 PubMed

Transpl Int. 2012 Sep;25(9):909-17 PubMed

Am J Transplant. 2009 Nov;9 Suppl 3:S1-155 PubMed

Am J Kidney Dis. 2009 Dec;54(6):1131-44 PubMed

Am J Kidney Dis. 1996 Jun;27(6):765-75 PubMed

Nephrol Dial Transplant. 2004 Jun;19 Suppl 3:iii47-51 PubMed

Am J Transplant. 2007 Dec;7(12):2748-56 PubMed

Nephrol Dial Transplant. 2010 Jan;25(1):25-31 PubMed

Kidney Int. 2006 Oct;70(7):1355-7 PubMed

Nat Rev Nephrol. 2012 Mar 06;8(5):301-6 PubMed

Pediatr Nephrol. 2005 Feb;20(2):210-6 PubMed

Am J Transplant. 2005 Feb;5(2):351-5 PubMed

Transpl Int. 2012 Nov;25(11):1165-73 PubMed