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Proteinuria following a switch from calcineurin inhibitors to sirolimus

Emmanuel Letavernier1, Marie-Noëlle Pe'raldi, Antoine Pariente

  • 1Service de Transplantation Adulte, Hôpital Necker, and Paris V University Service de Néphrologie et Transplantation, Hôpital Saint-Louis, Paris, France.

Transplantation
|November 30, 2005
PubMed
Abstract

Insights

Switching kidney transplant patients from calcineurin inhibitors (CNI) to sirolimus can cause proteinuria. This side effect appears reversible upon sirolimus withdrawal, suggesting careful patient selection is needed.

Area of Science:

  • Nephrology
  • Transplantation Immunology

Background:

  • Calcineurin inhibitors (CNI) are standard immunosuppressants for kidney transplant recipients.
  • Deteriorating renal function in CNI-treated patients prompts consideration of alternative agents like sirolimus.
  • The impact of switching from CNI to sirolimus on proteinuria requires investigation.

Purpose of the Study:

  • To investigate the incidence and reversibility of proteinuria after switching from CNI to sirolimus in kidney transplant recipients.
  • To assess the correlation between pre-existing proteinuria and post-switch renal function decline.

Main Methods:

  • Retrospective analysis of 68 kidney transplant recipients switched from CNI to sirolimus.
  • 24-hour urine collections for proteinuria measurement at baseline and 3, 6, 12, and 24 months post-switch.
  • Analysis of proteinuria changes in patients switched back to CNI and correlation with renal function.

Main Results:

  • Mean proteinuria increased significantly from 0.39 g/day at baseline to 1.44 g/day at 3 months post-switch (P<0.001).
  • Elevated proteinuria persisted at 6, 12, and 24 months.
  • Proteinuria decreased significantly (P<0.05) from 1.95 g/day to 0.9 g/day when sirolimus was withdrawn in 19 patients.
  • Pre-switch proteinuria >0.3 g/day correlated with subsequent renal function decrease.

Conclusions:

  • Kidney transplant recipients on CNI may experience reversible proteinuria when switched to sirolimus.
  • Monitoring proteinuria is crucial after switching to sirolimus.
  • Patients with pre-existing proteinuria may be at higher risk for adverse renal outcomes after the switch.

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