Journal Article

Screening for proteinuria in kidney transplant recipients

Romuald Panek, Tarek Lawen and Bryce A. Kiberd

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 4, pages 1385-1387
Published in print April 2011 | ISSN: 0931-0509
Published online August 2010 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq503
Screening for proteinuria in kidney transplant recipients

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Background. Proteinuria is a predictor of graft loss and death in kidney transplant recipients. This study examines the clinical significance of albumin-to-creatinine (ACR) and protein-to-creatinine (PCR) ratios compared with conventional dipstick measures of proteinuria.

Methods. At this single centre, 500 adult patients with a functioning kidney transplant > 4 months provided a urine sample for dipstick, ACR and PCR. The primary end point was defined as death-censored graft loss. Associations between proteinuria and graft loss were examined by concordance statistics and multivariate Cox models.

Results. There were 32 graft losses over a mean 2.98 years follow-up. PCR (c = 0.82, P < 0.001) and ACR (c = 0.83, P < 0.001) demonstrated similar concordance with events, and both scored higher than dipstick (c = 0.76, P < 0.001). ACR cut points of 30 and 300 mg/g for grading albuminuria were equivalent to 130 and 490 mg/g for PCR. Moderate grades of proteinuria by ACR and PCR were predicted of adverse events in a multivariate analysis.

Conclusions. ACR and PCR are probably equivalent in predicting adverse events. Conventional dipstick is also predictive but does not appear to be as sensitive.

Keywords: dipstick; graft loss; proteinuria; ratio; survival

Journal Article.  1740 words.  Illustrated.

Subjects: Nephrology

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