Importance du suivi de la protéinurie chez le transplanté
Néphrologie & Thérapeutique, ISSN: 1769-7255, Vol: 4, Issue: SUPPL.1, Page: S45-S49
2008
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Article Description
L’apparition d’une protéinurie est un marqueur de mauvais pronostic chez le patient transplanté. L’augmentation de la protéinurie est en effet associée à une augmentation du risque de décès global et de perte du greffon. Même de faible débit (< 0,5 g/j), la protéinurie a un impact négatif très significatif sur la survie du greffon, qu’elle survienne 1 ou 3 mois après transplantation. Le taux d’excrétion urinaire d’albumine a aussi un impact majeur sur les risques de perte de greffon et de décès avec rein fonctionnel, la macroalbuminurie augmentant les risques de respectivement 16,4 et 4,12 fois comparativement à la microalbuminurie, qui elle-même multiplie les risques par 14,2 et 5,5 respectivement, par rapport à une normoalbuminurie. Parmi les nombreux facteurs responsables de l’apparition d’une protéinurie, le rôle des inhibiteurs du signal de prolifération (PSI) a été constaté récemment. Le sirolimus, surtout à fortes doses, peut notamment provoquer l’apparition d’une protéinurie réversible à l’arrêt du traitement, mais avec une récupération seulement partielle de la fonction rénale. Cette protéinurie pourrait s’expliquer par un impact glomérulaire direct du sirolimus sur certains marqueurs podocytaires. The occurrence of proteinuria in transplant patients is a marker of poor prognosis. The augmentation of proteinuria is associated with an increased risk of patient death and graft loss. Even a low-level urinary protein excretion (0.5 g/d) has a highly significant negative impact on graft survival whether it is observed 1 or 3 months after transplantation. Urinary albumin excretion rate has also a major effect on risks of graft loss and death with functional kidney, macro-albuminuria increasing the risks of respectively 16.4 and 4.12 times comparatively to micro-albuminuria, which itself multiplies the risks by 14.2 and 5.5 respectively, compared to normo-albuminuria. In terms of factors causing proteinuria apparition, the role of proliferation signal inhibitors has been recently observed. Sirolimus, especially at high dose, in particular can induce the occurrence of proteinuria, which is reversible with treatment discontinuation, but only with a partial recovery of the renal function. Proteinuria may be explained by a direct glomerular impact of sirolimus on several podocyte markers.
Bibliographic Details
http://www.sciencedirect.com/science/article/pii/S1769725508736526; http://dx.doi.org/10.1016/s1769-7255(08)73652-6; http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=48849087683&origin=inward; http://www.ncbi.nlm.nih.gov/pubmed/18703399; https://linkinghub.elsevier.com/retrieve/pii/S1769725508736526; http://linkinghub.elsevier.com/retrieve/pii/S1769725508736526; http://api.elsevier.com/content/article/PII:S1769725508736526?httpAccept=text/xml; http://api.elsevier.com/content/article/PII:S1769725508736526?httpAccept=text/plain; http://dx.doi.org/10.1016/s1769-7255%2808%2973652-6; https://dx.doi.org/10.1016/s1769-7255%2808%2973652-6
John Libbey Eurotext
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