Proteinuria after conversion to sirolimus in kidney transplant recipients: impact of pre-existing proteinuria, graft function, and angiotensin-converting enzyme inhibitors/angiotensin-receptor antagonists.

Marx C, Busch M, Ott U, Gerth J, Wolf G. Proteinuria after conversion to sirolimus in kidney transplant recipients: impact of pre-existing proteinuria, graft function, and angiotensin-converting enzyme inhibitors/angiotensin-receptor antagonists. Clin Transplant 2009 DOI:10.1111/j.1399-0012.2009.01142.x. © 2009 John Wiley & Sons A/S. Abstract:  Background:  Proteinuria is a known side effect of therapy with sirolimus. The effect of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEI/ARB ) on sirolimus-associated proteinuria has not yet been assessed. Patients and methods:  A retrospective cohort study of renal transplant patients treated with sirolimus (n = 55) was performed. Results:  Of 55 patients, 24 (44%) had no proteinuria ( 0.15 g/d after 12 months, only 2 developed proteinuria > 1 g/d. The total number of proteinuria >1 g/d after 12 months including patients with pre-existing proteinuria >1 g/d (n = 3) was seven of 55 patients (13%). Multivariate regression analysis revealed pre-existing proteinuria > 0.15 g/d and reduced glomerular filtration rate as independent predictors for the development of proteinuria after conversion to sirolimus. Conclusion:  Reduced glomerular filtration rate and pre-existing proteinuria but not therapy with ACEI/ARB are independent predictors for proteinuria after conversion to sirolimus. Treatment with ACEI/ARB did not reduce pre-existing proteinuria after conversion except in single cases with severe proteinuria.