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Proteinuria associated with mTOR inhibitors after kidney transplant
Murat Guney1, Gulizar Sahin, Bilal Yilmaz
1From the Department of Nephrology, Haydarpasa Research and Training Hospital, Istanbul, Turkey.
Objectives:
The mammalian target of rapamycin inhibitors sirolimus and everolimus are immunosuppressive drugs for kidney transplant patients, but adverse events may include proteinuria. The purpose of this study was to compare the effects of sirolimus and everolimus on creatinine clearance and proteinuria after kidney transplant.
Materials And Methods:
This study was a prospective evaluation period of 50 patients (age, 16-65 y) who had kidney transplant. There were 25 patients who used sirolimus and 25 patients who used everolimus. Evaluation at the beginning mTOR and end of the evaluation period included complete blood count, blood pressure, serum creatinine level, creatinine clearance, and proteinuria level in a 24-hour urine collection.
Results:
Mean creatinine clearance at the beginning and end of the evaluation period was significantly less in the everolimus than sirolimus group. There was no significant change in creatinine clearance from the beginning to end of the evaluation period in either the sirolimus or everolimus group. Mean proteinuria at the beginning and end of the evaluation period was similar between the sirolimus and everolimus groups. Both groups had a significant increase in mean proteinuria from beginning to end of the evaluation period, but the increase in proteinuria was similar for the sirolimus and everolimus groups (difference not significant).
Conclusions:
In kidney transplant recipients, sirolimus and everolimus are associated with a similar level of increased mean proteinuria.
Insights
Sirolimus and everolimus, both mammalian target of rapamycin inhibitors, showed similar increases in proteinuria in kidney transplant patients. Creatinine clearance was lower with everolimus but did not change significantly within groups.
Area of Science:
- Nephrology
- Immunosuppression
- Pharmacology
Background:
- Mammalian target of rapamycin (mTOR) inhibitors like sirolimus and everolimus are crucial immunosuppressants for kidney transplant recipients.
- Proteinuria is a potential adverse event associated with these mTOR inhibitors.
Purpose of the Study:
- To compare the effects of sirolimus versus everolimus on creatinine clearance and proteinuria in kidney transplant patients.
- To evaluate the safety and efficacy of these two mTOR inhibitors post-transplantation.
Main Methods:
- Prospective study of 50 kidney transplant patients (25 sirolimus, 25 everolimus).
- Evaluated complete blood count, blood pressure, serum creatinine, creatinine clearance, and 24-hour proteinuria at baseline and end of study.
- Monitored patients over a defined evaluation period.
Main Results:
- Mean creatinine clearance was significantly lower in the everolimus group compared to the sirolimus group.
- No significant changes in creatinine clearance were observed within either the sirolimus or everolimus groups from baseline to end of study.
- Both groups experienced a similar significant increase in mean proteinuria, with no significant difference between sirolimus and everolimus.
Conclusions:
- Sirolimus and everolimus are associated with comparable increases in mean proteinuria in kidney transplant recipients.
- While creatinine clearance differed between groups, it remained stable within each treatment arm.
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