Proteinuria following conversion from azathioprine to sirolimus in renal transplant recipients
Recent studies have reported a significant increase of proteinuria in kidney transplant recipients who were switched from a calcineurin inhibitor (CI) to sirolimus. This has (partly) been ascribed to the hemodynamic renal effects of CI withdrawal. We have evaluated the evolution of proteinuria in re...
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| description | Recent studies have reported a significant increase of proteinuria in kidney transplant recipients who were switched from a calcineurin inhibitor (CI) to sirolimus. This has (partly) been ascribed to the hemodynamic renal effects of CI withdrawal. We have evaluated the evolution of proteinuria in renal transplant recipients who underwent conversion from azathioprine to sirolimus. In a randomized, prospective, multicenter study called RESCUE (Recurrent cutanEous Squamous cell Carcinoma Under RapamunE) the efficacy and safety is investigated of conversion to sirolimus in stable renal transplant recipients with a cutaneus squamous cell carcinoma (SCC). In our center 25 patients have been included in this study of which 13 patients were randomized to continue their current immunosuppressive treatment and 12 to conversion to sirolimus. After a mean follow-up of 360 days mean proteinuria increased from 0.37±0.34 to 1.81±1.73g/24h after conversion to sirolimus (P |
| doi_str_mv | 10.1038/sj.ki.5001792 |
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This has (partly) been ascribed to the hemodynamic renal effects of CI withdrawal. We have evaluated the evolution of proteinuria in renal transplant recipients who underwent conversion from azathioprine to sirolimus. In a randomized, prospective, multicenter study called RESCUE (Recurrent cutanEous Squamous cell Carcinoma Under RapamunE) the efficacy and safety is investigated of conversion to sirolimus in stable renal transplant recipients with a cutaneus squamous cell carcinoma (SCC). In our center 25 patients have been included in this study of which 13 patients were randomized to continue their current immunosuppressive treatment and 12 to conversion to sirolimus. After a mean follow-up of 360 days mean proteinuria increased from 0.37±0.34 to 1.81±1.73g/24h after conversion to sirolimus (P<0.005). In the control group there was no change in proteinuria. A significant increase of proteinuria was observed in all seven patients with proteinuria before conversion, whereas proteinuria remained absent in all patients without previous proteinuria. Two of the patients with proteinuria were converted from cyclosporine and five were converted from azathioprine to sirolimus. Sirolimus was discontinued in five patients with proteinuria, and in all of them proteinuria declined to baseline values. Our study demonstrates that conversion from azathioprine to sirolimus after kidney transplantation may cause a reversible increase of proteinuria. Sirolimus-induced proteinuria therefore cannot be ascribed to the hemodynamic renal effects of withdrawal of CI.</description><identifier>ISSN: 0085-2538</identifier><identifier>EISSN: 1523-1755</identifier><identifier>DOI: 10.1038/sj.ki.5001792</identifier><identifier>PMID: 16912706</identifier><identifier>CODEN: KDYIA5</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Azathioprine - therapeutic use ; Biological and medical sciences ; Calcineurin Inhibitors ; Carcinoma, Squamous Cell - prevention & control ; Creatinine - blood ; Creatinine - urine ; Female ; Follow-Up Studies ; Humans ; Immunosuppression ; Immunosuppressive Agents - adverse effects ; Immunosuppressive Agents - therapeutic use ; Kidney - drug effects ; Kidney Transplantation ; Male ; Medical sciences ; Middle Aged ; Nephrology. Urinary tract diseases ; nephrotoxicity ; Prospective Studies ; proteinuria ; Proteinuria - chemically induced ; Proteinuria - diagnosis ; renal transplantation ; sirolimus ; Sirolimus - adverse effects ; Skin Neoplasms - prevention & control ; Time Factors ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. 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This has (partly) been ascribed to the hemodynamic renal effects of CI withdrawal. We have evaluated the evolution of proteinuria in renal transplant recipients who underwent conversion from azathioprine to sirolimus. In a randomized, prospective, multicenter study called RESCUE (Recurrent cutanEous Squamous cell Carcinoma Under RapamunE) the efficacy and safety is investigated of conversion to sirolimus in stable renal transplant recipients with a cutaneus squamous cell carcinoma (SCC). In our center 25 patients have been included in this study of which 13 patients were randomized to continue their current immunosuppressive treatment and 12 to conversion to sirolimus. After a mean follow-up of 360 days mean proteinuria increased from 0.37±0.34 to 1.81±1.73g/24h after conversion to sirolimus (P<0.005). In the control group there was no change in proteinuria. A significant increase of proteinuria was observed in all seven patients with proteinuria before conversion, whereas proteinuria remained absent in all patients without previous proteinuria. Two of the patients with proteinuria were converted from cyclosporine and five were converted from azathioprine to sirolimus. Sirolimus was discontinued in five patients with proteinuria, and in all of them proteinuria declined to baseline values. Our study demonstrates that conversion from azathioprine to sirolimus after kidney transplantation may cause a reversible increase of proteinuria. Sirolimus-induced proteinuria therefore cannot be ascribed to the hemodynamic renal effects of withdrawal of CI.</description><subject>Aged</subject><subject>Azathioprine - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Calcineurin Inhibitors</subject><subject>Carcinoma, Squamous Cell - prevention & control</subject><subject>Creatinine - blood</subject><subject>Creatinine - urine</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kidney - drug effects</subject><subject>Kidney Transplantation</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nephrology. Urinary tract diseases</subject><subject>nephrotoxicity</subject><subject>Prospective Studies</subject><subject>proteinuria</subject><subject>Proteinuria - chemically induced</subject><subject>Proteinuria - diagnosis</subject><subject>renal transplantation</subject><subject>sirolimus</subject><subject>Sirolimus - adverse effects</subject><subject>Skin Neoplasms - prevention & control</subject><subject>Time Factors</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. Prostate gland</subject><issn>0085-2538</issn><issn>1523-1755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp10LtrHDEQwGEREuLzo0wbRCDlXkar1T5KY_IwGJLCbi20upE95z3pLGkd7L_eCrfgKpWQ-BhGP8Y-CVgLkP23tF0_0FoBiG6o37GVULWsRKfUe7YC6FVVK9kfseOUtlDug4SP7Ei0g6g7aFfs9k8MGcnPkQx3YZrCX_J33Ab_hDFR8NzFsOPmxeR7CvtIHnkOPFEME-3mxMnziN5MPEfj034yPpcHS3tCn9Mp--DMlPBsOU_YzY_v1xe_qqvfPy8vzq8q20iVK6EGgaZtoHajMQ12G-vGUeLYuFEaq3oxYvmiGroOoGkQrHG9qft2gL611soT9uUwdx_D44wp622YY1kr6VqAqGXJU1B1QDaGlCI6Xf6zM_FZC9D_Yuq01Q-kl5jFf16GzuMON296qVfA1wWYZM3kSgFL6c31RUqA4rqDw5LgiTDqZEseixsqqbLeBPrPCq8Q1ZKI</recordid><startdate>20061001</startdate><enddate>20061001</enddate><creator>van den Akker, J.M.</creator><creator>Wetzels, J.F.M.</creator><creator>Hoitsma, A.J.</creator><general>Elsevier Inc</general><general>Nature Publishing</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20061001</creationdate><title>Proteinuria following conversion from azathioprine to sirolimus in renal transplant recipients</title><author>van den Akker, J.M. ; Wetzels, J.F.M. ; Hoitsma, A.J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c435t-1591ea6402fbaa4e7dcfbb3eb4fb3ac581be50059770044e0caf8a2869086ccc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Aged</topic><topic>Azathioprine - therapeutic use</topic><topic>Biological and medical sciences</topic><topic>Calcineurin Inhibitors</topic><topic>Carcinoma, Squamous Cell - prevention & control</topic><topic>Creatinine - blood</topic><topic>Creatinine - urine</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kidney - drug effects</topic><topic>Kidney Transplantation</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Nephrology. Urinary tract diseases</topic><topic>nephrotoxicity</topic><topic>Prospective Studies</topic><topic>proteinuria</topic><topic>Proteinuria - chemically induced</topic><topic>Proteinuria - diagnosis</topic><topic>renal transplantation</topic><topic>sirolimus</topic><topic>Sirolimus - adverse effects</topic><topic>Skin Neoplasms - prevention & control</topic><topic>Time Factors</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Urinary tract. Prostate gland</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van den Akker, J.M.</creatorcontrib><creatorcontrib>Wetzels, J.F.M.</creatorcontrib><creatorcontrib>Hoitsma, A.J.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Kidney international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van den Akker, J.M.</au><au>Wetzels, J.F.M.</au><au>Hoitsma, A.J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Proteinuria following conversion from azathioprine to sirolimus in renal transplant recipients</atitle><jtitle>Kidney international</jtitle><addtitle>Kidney Int</addtitle><date>2006-10-01</date><risdate>2006</risdate><volume>70</volume><issue>7</issue><spage>1355</spage><epage>1357</epage><pages>1355-1357</pages><issn>0085-2538</issn><eissn>1523-1755</eissn><coden>KDYIA5</coden><abstract>Recent studies have reported a significant increase of proteinuria in kidney transplant recipients who were switched from a calcineurin inhibitor (CI) to sirolimus. This has (partly) been ascribed to the hemodynamic renal effects of CI withdrawal. We have evaluated the evolution of proteinuria in renal transplant recipients who underwent conversion from azathioprine to sirolimus. In a randomized, prospective, multicenter study called RESCUE (Recurrent cutanEous Squamous cell Carcinoma Under RapamunE) the efficacy and safety is investigated of conversion to sirolimus in stable renal transplant recipients with a cutaneus squamous cell carcinoma (SCC). In our center 25 patients have been included in this study of which 13 patients were randomized to continue their current immunosuppressive treatment and 12 to conversion to sirolimus. After a mean follow-up of 360 days mean proteinuria increased from 0.37±0.34 to 1.81±1.73g/24h after conversion to sirolimus (P<0.005). In the control group there was no change in proteinuria. A significant increase of proteinuria was observed in all seven patients with proteinuria before conversion, whereas proteinuria remained absent in all patients without previous proteinuria. Two of the patients with proteinuria were converted from cyclosporine and five were converted from azathioprine to sirolimus. Sirolimus was discontinued in five patients with proteinuria, and in all of them proteinuria declined to baseline values. Our study demonstrates that conversion from azathioprine to sirolimus after kidney transplantation may cause a reversible increase of proteinuria. Sirolimus-induced proteinuria therefore cannot be ascribed to the hemodynamic renal effects of withdrawal of CI.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>16912706</pmid><doi>10.1038/sj.ki.5001792</doi><tpages>3</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Azathioprine - therapeutic use Biological and medical sciences Calcineurin Inhibitors Carcinoma, Squamous Cell - prevention & control Creatinine - blood Creatinine - urine Female Follow-Up Studies Humans Immunosuppression Immunosuppressive Agents - adverse effects Immunosuppressive Agents - therapeutic use Kidney - drug effects Kidney Transplantation Male Medical sciences Middle Aged Nephrology. Urinary tract diseases nephrotoxicity Prospective Studies proteinuria Proteinuria - chemically induced Proteinuria - diagnosis renal transplantation sirolimus Sirolimus - adverse effects Skin Neoplasms - prevention & control Time Factors Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland |
| title | Proteinuria following conversion from azathioprine to sirolimus in renal transplant recipients |
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