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What causes proteinuria after a kidney transplant?

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Posted on Sat, 19 Apr 2014
Question: My son, who is 30, has ARPKD and had his first kidney transplant at age 10, then another one at 24. Both living donors. Well, now, 6 and half years into his second transplant, his microalbumin, urine and ratio are going up dramatically. His Microalbumin is 604 and the ratio is 1793.3. His CR is 2.55 and BUN is 57. However, his creatinine clearance after a 24 hour urine is 63.81 mL/minute. So, his Nephrologist is saying he's stable for now with the kidney function, BUT is unsure of what to do next. He has been talking about taking the chemotherapy durg, Rituxin, but are worried about the immune suppression being even worse on this drug. He had a kidney biospy a year ago and it showed no rejection. Any ideas of what could be causing this huge jump in microalbumin? Also, he had been put on Losartan a year ago and it did seem to control this, until just recently. Any advice would be appreciated. He and and his doctor live 7 hours away and I can't ask his doctor these detailed questions because of HIPPA rules, etc. Can somebody give me some guidance? A worried Dad.
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Answered by Dr. Ravi Bansal (13 hours later)
Brief Answer: post transplant proteinuria Detailed Answer: Hi XXXX, the proteinuria after transplant is generally due to following causes- 1.De-novo glomerulonephritis. like FSGS 2.Chronic allograft nephropathy- slow deterioration of kidney function after years of tranplant. How to approach: Put patient on Ace inhibitors like losartan or telmisartan, keep bp less than 130/80 Watch for progressive increase in proteinuria and creatinine levels. ( every 2 weeks for a couple of months. If progression then repeat kidney biopsy.) I need to see the detailed report of kidney biopsy, to comment on the findings. the amount of proteinuria you are describing is actually not very large - if it is greater than 3000 mg/day then we call it nephrotic or large amount. If the proteinuria and serum creatinine are stable and not rising- do not worry - no special intervention is required . You can discuss with your treating nephrologist. Best Wishes
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ravi Bansal (7 hours later)
Dr. Bansal, Thank you, this was very helpful and helps me understand it better. I am sure my son's Nephrologist explained this to my son, but my son doesn't tell me all these details so thank you. By the way, he has been on Losartan for about six months and things were getting better and than it just sort of exploded recently.
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Answered by Dr. Ravi Bansal (3 hours later)
Brief Answer: proteinuria in transplant patient. Detailed Answer: Hi, Proteinuria can change with time and there are many influences which can increase proteinuria. Did he suffer from any infection- sore throat or urine infection. Did he have lot of non-veg ( meat) in diet prior to the day of testing. You can repeat the test to confirm. Generally do in second morning sample . first sample may give high value. Then on the other hand it can be progression of kidney disease as i described earlier. Best wishes.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Ravi Bansal

Nephrologist

Practicing since :1996

Answered : 359 Questions

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What causes proteinuria after a kidney transplant?

Brief Answer: post transplant proteinuria Detailed Answer: Hi XXXX, the proteinuria after transplant is generally due to following causes- 1.De-novo glomerulonephritis. like FSGS 2.Chronic allograft nephropathy- slow deterioration of kidney function after years of tranplant. How to approach: Put patient on Ace inhibitors like losartan or telmisartan, keep bp less than 130/80 Watch for progressive increase in proteinuria and creatinine levels. ( every 2 weeks for a couple of months. If progression then repeat kidney biopsy.) I need to see the detailed report of kidney biopsy, to comment on the findings. the amount of proteinuria you are describing is actually not very large - if it is greater than 3000 mg/day then we call it nephrotic or large amount. If the proteinuria and serum creatinine are stable and not rising- do not worry - no special intervention is required . You can discuss with your treating nephrologist. Best Wishes