Abstract
Proteinuria after kidney transplantation is an independent risk factor for increased cardiovascular mortality and morbidity as in the general population. There was also found a relationship between the level of proteinuria and graft and transplant patients survival.
Prevalence of proteinuria in kidney transplant patients ranges from 7-45 %. In terms of the type of proteinuria, proteinuria after kidney transplantation is usually a mixed type with frequent occurrence of tubular proteinuria.
One of the risk factors of proteinuria after kidney transplantation is donor age, delayed graft function, incidence of acute rejection, increased blood pressure, sirolimus therapy and in some studies also recipient age, cause of death of donor, HCV positivity and recipients higher BMI. The relationship of proteinuria and graft and patient survival after kidney transplantation has shown a correlation between the degree of proteinuria and increased risk of graft loss, death of the patient respectively.
In histological findings, when proteinuria is > 1.5 g/day, there is a high incidence of glomerular damage, whereas other types of kidney damage are much less frequent. As a pathophysiological mechanism caused by proteinuria for graft function failure applies damage of kidney mesangium as a result of mesangial protein overload, and also proximal tubular dysfunction as a result of an abnormal amount and composition of proteins in the tubular lumen.
Angiotensinconverting enzyme inhibitors and angiotensin receptor blockers are indispensable in the treatment of proteinuria. Other measures are reduction of blood pressure, treatment of blood lipids and body weight reduction in overweight.