Removal of glucocordicoids influences the occurrence of microalbuminuria in recipients receiving renal transplantation

doi:10.3969/j.issn.2095-4344.2014.36.006

Abstract

Abstract:

BACKGROUND: Long-term use of corticosteroids (hereinafter referred to as hormone) after renal transplantation could obviously lead to adverse reactions. Immunosuppressive regimen with less and no hormone has been a hot focus in the study of renal transplantation all over the world. However, reduction or withdrawal of hormones has a certain risk. At present, there is no unified scheme. Because urine protein can be immediately detected after tubular injury, to monitor urine protein can find the renal dysfunction after transplantation in recipients undergoing renal transplantation, which can gain time for clinical therapy.
OBJECTIVE: To discuss the influence of hormone (prednisone) removal on the occurrence of urine protein in recipients undergoing renal transplantation.
METHODS: A total of 35 recipients undergoing renal transplantation after removal of prednisone received immunosuppressive regimen of cyclosporine A or tacrolimus + mycophenolate mofetil bivalent. Initial dose of prednisone was 30 mg/d, and then gradually reduced by 5 mg per week, and withdrawn at 1 month after renal transplantation. There were 16 cases in cyclosporine A group and 19 cases in tacrolimus group. Urine protein was measured and quantified at 3, 6, 12 and 24 months after renal transplantation and 3, 6 and 12 months after addition of prednisone in both groups. Simultaneously, serum creatinine, fasting glucose, body mass increases, the rate of acute rejection, infection, patient/graft survival at 2 years after renal transplantation and urine protein at 24 hours before and after adding hormone were recorded.
RESULTS AND CONCLUSION: For the two groups, urine α1-microglobulin started to rise after 6 months of removal of prednisone. Urinary microalbumin, urinary α1-microglobulin, and urinary transferrin ascended obviously at 12 months. Urinary protein was positive in five cases of cyclosporine A group and in three cases of tacrolimus group. At 24 months, urinary microalbumin, urinary α1-microglobulin, urinary transferrin and urinary IgG ascended obviously. Urinary protein was positive in cyclosporine A group with 11 cases and in tacrolimus group with 10 cases. 24-hour urinary protein quantity was more than 1 g in every case. On this base, we made the patients to take more prednisone for 6 months, so urine α1-microglobulin and urinary microalbumin began to descend. Each group had one case of positive urinary protein turning to negative. Twelve months after the adjustment of the prednisone, urinary microalbumin, urinary α1-microglobulin, and urinary transferrin descended respectively. Positive urinary protein turned into negative: in cyclosporine A group with two cases and in tacrolimus group with three cases. 24-hour urinary protein quantity was around 0.7 g. Two years after renal transplantation, serum creatinine and acute rejection rates were higher in the cyclosporine A group than in the tacrolimus group (P < 0.05). No significant difference in fasting glucose, body mass increase, infections, and patient/graft survival was detectable between both groups. Results suggested that removal of prednisone greatly affected urine protein in recipients undergoing renal transplantation. In particular, at 2 years after renal transplantation, urinary microalbumin, urinary α1-microglobulin, urinary transferrin and urinary IgG ascended obviously, and the security needs further research.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: kidney transplantation, glucocorticoids, prednisone

CLC Number:

R318

Zuo Fu-jie, Wang Li-ming, Feng Xiao-fang, Min Min, Han Shu. Removal of glucocordicoids influences the occurrence of microalbuminuria in recipients receiving renal transplantation[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(36): 5770-5775.

Figures/Tables 1

2.1 参与者数量分析由专人对患者临床资料进行调查、分析，无脱落例数，合格率100%。 2.2 两组一般情况比较两组患者的人口统计学特征、配型等差异均无显著性意义，两组具有可比性(表1)。 2.3 撤除激素后两组患者的尿微量蛋白比较肾移植后3个月尿微量蛋白恢复至正常水平。肾移植后6个月，尿α1-微球蛋白开始升高(P < 0.05)，而尿微量白蛋白、尿免疫球蛋白(Ig)G、尿转铁蛋白无明显变化(均为P > 0.05)。肾移植后12个月，尿微量白蛋白、尿α1-微球蛋白、尿转铁蛋白明显升高(均为P < 0.05)。肾移植后24个月，尿微量白蛋白、尿α1-微球蛋白、尿转铁蛋白、尿免疫球蛋白(Ig)G均明显升高(均为P < 0.05，表2)。两组同一时间段尿微量蛋白比较差异无显著性意义(均为P > 0.05)。尿蛋白阳性：肾移植后3个月0例；肾移植后6个月，环孢素A组弱阳性1例(6.3%)，他克莫司组0例；肾移植后12个月，环孢素A组阳性5例(31.3%)，他克莫司组3例(15.8%)；肾移植后24个月，环孢素A组阳性11例(68.8%)，他克莫司组10例(52.6%)。 2.4 加服激素(泼尼松)后两组患者的尿微量蛋白比较服用激素(泼尼松)后3个月，尿微量白蛋白开始下降(P < 0.05)，而尿α1-微球蛋白、尿免疫球蛋白(Ig)G、尿转铁蛋白、24 h尿蛋白定量无明显变化(均为P > 0.05)。服后激素6个月，尿微量白蛋白、尿α1-微球蛋白进一步下降(均为 P < 0.05)。加服激素后12个月，尿微量白蛋白、尿α1-微球蛋白、尿转铁蛋白、24 h尿蛋白定量均下降(均为P < 0.05)，而尿免疫球蛋白(Ig)G无明显变化(P > 0.05，表3)。两组同一时间段尿微量蛋白比较差异无显著性意义(均为P > 0.05)。尿蛋白阳性：服后3个月，环孢素A组仍11例，他克莫司组仍10例；服后6个月，环孢素A组10例(62.5%)，他克莫司组9例(47.4%)；服后12个月，环孢素A组9例(56.3%)，他克莫司组7例(36.8%)。 2.5 肾移植后2年两组各项指标比较肾移植后2年，环孢素A组血肌酐水平、急性排斥率高于他克莫司组(P < 0.05)，空腹血糖、体质量增加、感染及人/肾存活率均无明显差异(P > 0.05，表4)。"

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