BACKGROUND: Proteinuria is a common manifestation of chronic kidney disease (CKD), and there is a high incidence of CDK and its complications following renal transplantation. However, little data are available on the association between proteinuria and graft/patient survival in the paediatric transplant population. The primary aim of this study was to investigate the associations between posttransplant proteinuria and graft/patient survival in children after renal transplantation. METHODS: In this retrospective study, we screened all 91 children receiving renal allografts at a single institution between 1997 and 2007. The inclusion criteria were a functioning graft at 1 year posttransplant, data availability and no recurrence of focal-segmental glomerulosclerosis. The final cohort included 75 patients. Proteinuria was considered to be pathologic if the urinary protein/creatinine ratio was >30 mg/mmol. Donor and recipient characteristics, data on proteinuria, estimated glomerular filtration rate (eGFR) and rejection episodes were analysed. The most recent of the biopsies performed during the follow-up after 1 year posttransplant were analysed separately in the proteinuric group and the non-proteinuric group. RESULTS: Proteinuria at 1-year posttransplant was pathologic in 35 % of patients. The 5-year graft survival rate was significantly lower in the proteinuric group than in the non-proteinuric group (77 vs. 100 %; p < 0.001). Proteinuria at 1 year posttransplant was associated with reduced long-term graft survival independent of other risk factors, including decreased eGFR or episodes of acute corticosensitive and corticoresistant rejection. The most frequent histologic finding in the proteinuric group was chronic rejection. There was no significant difference in the 5-year patient survival rate between the proteinuric group and the non-proteinuric group. CONCLUSION: This study emphasizes the importance of proteinuria as a prognostic factor of renal allograft survival in children.

• MeSH
• alografty MeSH
• biopsie MeSH
• časové faktory MeSH
• chronické selhání ledvin chirurgie   MeSH
• dítě MeSH
• hodnoty glomerulární filtrace MeSH
• incidence MeSH
• kreatinin moč   MeSH
• ledviny patologie   patofyziologie   MeSH
• lidé MeSH
• míra přežití trendy   MeSH
• mladiství MeSH
• následné studie MeSH
• opožděný nástup funkce štěpu komplikace   epidemiologie   moč   MeSH
• předškolní dítě MeSH
• přežívání štěpu * MeSH
• prognóza MeSH
• proteinurie epidemiologie   etiologie   moč   MeSH
• retrospektivní studie MeSH
• transplantace ledvin škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• kreatinin MeSH

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.

• MeSH
• antagonisté receptorů pro angiotenzin terapeutické užití   MeSH
• antihypertenziva terapeutické užití   MeSH
• časové faktory MeSH
• chronické selhání ledvin diagnóza   etiologie   chirurgie   MeSH
• fokálně segmentální glomeruloskleróza komplikace   diagnóza   MeSH
• hypertenze komplikace   diagnóza   farmakoterapie   MeSH
• imunosupresiva škodlivé účinky   MeSH
• inhibitory ACE terapeutické užití   MeSH
• lidé MeSH
• přežívání štěpu MeSH
• proteinurie diagnóza   etiologie   patofyziologie   terapie   MeSH
• recidiva MeSH
• rejekce štěpu diagnóza   etiologie   terapie   MeSH
• renin-angiotensin systém účinky léků   MeSH
• rizikové faktory MeSH
• TOR serin-threoninkinasy antagonisté a inhibitory   MeSH
• transplantace ledvin škodlivé účinky   MeSH
• věkové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH
• Názvy látek
• antagonisté receptorů pro angiotenzin MeSH
• antihypertenziva MeSH
• imunosupresiva MeSH
• inhibitory ACE MeSH
• MTOR protein, human MeSH Prohlížeč
• TOR serin-threoninkinasy MeSH

Hypertension is a common and serious complication after renal transplantation. It is an important risk factor for graft loss and adverse cardiovascular outcomes. Blood pressure (BP) in transplanted children should be measured not only by clinic BP (cBP) measurement, but also by ambulatory blood pressure monitoring (ABPM), because ABPM has distinct advantages over cBP, specifically the ability to reveal nocturnal, masked or white-coat hypertension. These types of hypertension are common in transplanted children (nocturnal hypertension 36-71 %, masked hypertension 24-45 %). It may also reveal uncontrolled hypertension in treated children, thereby improving control of hypertension. Regular use of ABPM and ABPM-guided therapy of hypertension may help to decrease cardiovascular and renal target organ damage in transplanted children. Therefore, ABPM should be routinely performed in all transplanted children at least once a year, regardless of the values of cBP.

• MeSH
• ambulantní monitorování krevního tlaku metody   MeSH
• časové faktory MeSH
• dítě MeSH
• hypertenze diagnóza   MeSH
• lidé MeSH
• maskovaná hypertenze diagnóza   MeSH
• pooperační komplikace diagnóza   MeSH
• přežívání štěpu MeSH
• syndrom bílého pláště diagnóza   MeSH
• transplantace ledvin * MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

Proteinuria is a common complication after renal transplantation (RTx). In adults, tubular proteinuria prevails and is associated with impaired graft survival. In the absence of studies on proteinuria profiling in transplanted children, we aimed at analyzing the types of proteinuria in transplanted children. Fifty-three children (11.8 years) were analyzed in a cross-sectional study. Morning urine was tested for total protein (PROT), albumin (ALB) and alpha-1-microglobulin (AMG). The type of proteinuria was assessed by the alpha-1-microglobulin/albumin algorithm (AAA): [AAA = AMG x 100/(AMG+ALB]. Median PROT, ALB, and AMG (in mg/mmol creatinine) were 20.0, 3.8, and 4.9, respectively. Pathological total proteinuria (>22 mg protein/mmol creatinine) was found in 47% of children (25/53). Only 20% of patients with pathological total proteinuria (5/25) had glomerular proteinuria, whereas 80% (20/25) had tubular proteinuria. Three of five children with glomerular proteinuria had chronic allograft nephropathy. Both AMG and albuminuria negatively correlated with the estimated glomerular filtration rate (eGFR) (p = 0.021 and 0.003, respectively). In conclusion, tubular proteinuria was present in 80% of children post-RTx and may be associated with impaired graft function; glomerular proteinuria is associated mainly with chronic allograft nephropathy.

• MeSH
• albuminurie patofyziologie   moč   MeSH
• alfa-globuliny analýza   MeSH
• algoritmy MeSH
• dítě MeSH
• glomerulus patofyziologie   MeSH
• homologní transplantace patologie   MeSH
• ledvinové kanálky patofyziologie   MeSH
• lidé MeSH
• proteinurie komplikace   patofyziologie   moč   MeSH
• průřezové studie MeSH
• rejekce štěpu moč   MeSH
• sérový albumin analýza   MeSH
• transplantace ledvin škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• alfa-globuliny MeSH
• alpha-1-microglobulin MeSH Prohlížeč
• sérový albumin MeSH