the prevalence of immunologic injury in renal allograft recipients with de novo proteinuria在肾移植受者免疫损伤的患病率与新创蛋白尿.pdfVIP

The Prevalence of Immunologic Injury in Renal Allograft Recipients with De Novo Proteinuria Qiquan Sun*, Song Jiang, Xue Li, Xianghua Huang, Kenan Xie, Dongrui Cheng, Jinsong Chen, Shuming Ji, Jiqiu Wen, Mingchao Zhang, Caihong Zeng, Zhihong Liu Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China Abstract Post-transplant proteinuria is a common complication after renal transplantation; it is associated with reduced graft and recipient survival. However, the prevalence of histological causes has been reported with considerable variation. A clinico- pathological re-evaluation of post-transplant proteinuria is necessary, especially after dismissal of the term ‘‘chronic allograft nephropathy,’’ which had been considered to be an important cause of proteinuria. Moreover, urinary protein can promote interstitial inflammation in native kidney, whether this occurs in renal allograft remains unknown. Factors that affect the graft outcome in patients with proteinuria also remain unclear. Here we collected 98 cases of renal allograft recipients who developed proteinuria after transplant, histological features were characterized using Banff scoring system. Cox proportional hazard regression models were used for graft survival predictors. We found that transplant glomerulopathy was the leading (40.8%) cause of post-transplant proteinuria. Immunological causes, including transplant glomerulopathy, acute rejection, and chronic rejection accounted for the majority of all pathological causes of proteinuria. Nevertheless, almost all patients that developed proteinuria had immunological lesions in the graft, especially for interstitial inflammation. Intraglomerular C3 deposition was unexpectedly correlated with the severity of proteinuria. Moreover, the severity of interstitial