Kidney transplant nephrotic syndrome
Lupus Erythematosus, Systemic
The incidence and clinical spectrum of nephrotic syndrome following kidney transplantation was evaluated in 81 patients who received a transplant between 1963 and 1971, and whose transplant functioned more than 10 months. The nephrotic syndrome developed in 24 patients (29.6 per cent). Eighteen patients received kidneys from living related donors, and six from cadaver donors. The original kidney disease was chronic glomerulonephritis in 15 patients and nonimmunologic diseases in 9. The over-all incidence of the transplant nephrotic syndrome did not differ between these two groups of patients. However, in patients with chronic glomerulonephritis, who had the nephrotic syndrome in the course of their original disease, the incidence of transplant nephrotic syndrome was higher than in those without a history of nephrotic syndrome. Most patients had one or more episodes of rejection prior to the onset of the nephrotic syndrome, and in about two thirds of the patients the nephrotic syndrome developed within 1 year after transplantation. Pathologic studies suggest that chronic rejection is the most common cause of the transplant nephrotic syndrome. The majority of patients had hypoalbuminemia and hyperlipidemia with increased beta lipoprotein, but urine protein was fairly selective, and the patients had minimal edema. Creatinine clearance at the beginning of the nephrotic syndrome was 10 to 70 ml/min (average 47 ml/min). Thirteen patients continued to do well for 16 to 94 months (average 51 months) after receiving their transplant with an average creatinine clearance of 47 ml/ min. There was no significant difference in graft or patient survival between transplant recipients who had the nephrotic syndrome and those who did not. Once the nephrotic syndrome is established, it appears to persist regardless of steroid or other immunosuppressive therapy. © 1974.
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