Is Proteinuria Reversible, After Withdrawal of Mammalian Target of Rapamycin Inhibitors?
Abstract Conversion to mammalian target of rapamycin inhibitors (mTORi) is an ever more frequent practice in renal transplant recipients, even if it is not always satisfactory, needing to be suspended for various reasons in certain patients. We analyzed the evolution of proteinuria as a marker of ki...
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description | Abstract Conversion to mammalian target of rapamycin inhibitors (mTORi) is an ever more frequent practice in renal transplant recipients, even if it is not always satisfactory, needing to be suspended for various reasons in certain patients. We analyzed the evolution of proteinuria as a marker of kidney damage after withdrawal of mTORi for any reason in order to assess conversion failure risk. Among 1633 renal transplant patients with 185 converted to mTORi, we considered the 52 (28%) who withdrew as result of intolerance or a bad evolution after at least 3 months use (median: 142 days after conversion). Four groups were defined according to the evolution of proteinuria: group 1 (G1), stable after conversion; group 2 (G2), increased with complete recovery (1 g); or group 4 (G4), increased without recovery. The evolution according to the groups was: G1 (57.1%), G2 (17.2%), G3 (5.7%), and G4 (20%). There were no differences between the good (G1 and G2) and the bad evolution groups (G3 and G4) in proteinuria at the time of conversion (838 ± 641 vs 532 ± 404 mg/d) or renal function (1.95 ± 0.47 vs 1.90 ± 0.4 mg/dL). Six months after withdrawal, proteinuria was stable in G1 and G2 but worse in G3 and G4 (781 ± 643 vs 4479 ± 3235 mg/d); the same observation was noted for renal failure (2.1 ± 0.71 vs 2.8 ± 1.57 mg/dL). Among about 75% of patients in whom mTORi was withdrawn, no injury remained in the medium term whereas among the other 25%, there was a residual injury. |
doi_str_mv | 10.1016/j.transproceed.2011.06.045 |
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We analyzed the evolution of proteinuria as a marker of kidney damage after withdrawal of mTORi for any reason in order to assess conversion failure risk. Among 1633 renal transplant patients with 185 converted to mTORi, we considered the 52 (28%) who withdrew as result of intolerance or a bad evolution after at least 3 months use (median: 142 days after conversion). Four groups were defined according to the evolution of proteinuria: group 1 (G1), stable after conversion; group 2 (G2), increased with complete recovery (<1 g); group 3 (G3), increased with partial recovery (>1 g); or group 4 (G4), increased without recovery. The evolution according to the groups was: G1 (57.1%), G2 (17.2%), G3 (5.7%), and G4 (20%). There were no differences between the good (G1 and G2) and the bad evolution groups (G3 and G4) in proteinuria at the time of conversion (838 ± 641 vs 532 ± 404 mg/d) or renal function (1.95 ± 0.47 vs 1.90 ± 0.4 mg/dL). Six months after withdrawal, proteinuria was stable in G1 and G2 but worse in G3 and G4 (781 ± 643 vs 4479 ± 3235 mg/d); the same observation was noted for renal failure (2.1 ± 0.71 vs 2.8 ± 1.57 mg/dL). Among about 75% of patients in whom mTORi was withdrawn, no injury remained in the medium term whereas among the other 25%, there was a residual injury.</description><identifier>ISSN: 0041-1345</identifier><identifier>EISSN: 1873-2623</identifier><identifier>DOI: 10.1016/j.transproceed.2011.06.045</identifier><identifier>PMID: 21839231</identifier><identifier>CODEN: TRPPA8</identifier><language>eng</language><publisher>Amsterdam: Elsevier Inc</publisher><subject>Biological and medical sciences ; Biomarkers - blood ; Calcineurin Inhibitors ; Creatinine - blood ; Drug Substitution ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Graft Rejection - immunology ; Graft Rejection - prevention & control ; Humans ; Immunosuppressive Agents - administration & dosage ; Immunosuppressive Agents - adverse effects ; Kidney Transplantation - immunology ; Medical sciences ; Nephrology. Urinary tract diseases ; Proteinuria - blood ; Proteinuria - chemically induced ; Proteinuria - drug therapy ; Retrospective Studies ; Spain ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Time Factors ; Tissue, organ and graft immunology ; TOR Serine-Threonine Kinases - antagonists & inhibitors ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. Prostate gland</subject><ispartof>Transplantation proceedings, 2011-07, Vol.43 (6), p.2194-2195</ispartof><rights>Elsevier Inc.</rights><rights>2011 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2011 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-7eee955227b916a71378975a8d8255ce5b7c80b4c3eacb343db537fa5cbc509f3</citedby><cites>FETCH-LOGICAL-c464t-7eee955227b916a71378975a8d8255ce5b7c80b4c3eacb343db537fa5cbc509f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.transproceed.2011.06.045$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>309,310,314,780,784,789,790,3550,23930,23931,25140,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=24444365$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21839231$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arnau, A</creatorcontrib><creatorcontrib>Ruiz, J.C</creatorcontrib><creatorcontrib>Rodrigo, E</creatorcontrib><creatorcontrib>Quintanar, J.A</creatorcontrib><creatorcontrib>Arias, M</creatorcontrib><title>Is Proteinuria Reversible, After Withdrawal of Mammalian Target of Rapamycin Inhibitors?</title><title>Transplantation proceedings</title><addtitle>Transplant Proc</addtitle><description>Abstract Conversion to mammalian target of rapamycin inhibitors (mTORi) is an ever more frequent practice in renal transplant recipients, even if it is not always satisfactory, needing to be suspended for various reasons in certain patients. We analyzed the evolution of proteinuria as a marker of kidney damage after withdrawal of mTORi for any reason in order to assess conversion failure risk. Among 1633 renal transplant patients with 185 converted to mTORi, we considered the 52 (28%) who withdrew as result of intolerance or a bad evolution after at least 3 months use (median: 142 days after conversion). Four groups were defined according to the evolution of proteinuria: group 1 (G1), stable after conversion; group 2 (G2), increased with complete recovery (<1 g); group 3 (G3), increased with partial recovery (>1 g); or group 4 (G4), increased without recovery. The evolution according to the groups was: G1 (57.1%), G2 (17.2%), G3 (5.7%), and G4 (20%). There were no differences between the good (G1 and G2) and the bad evolution groups (G3 and G4) in proteinuria at the time of conversion (838 ± 641 vs 532 ± 404 mg/d) or renal function (1.95 ± 0.47 vs 1.90 ± 0.4 mg/dL). Six months after withdrawal, proteinuria was stable in G1 and G2 but worse in G3 and G4 (781 ± 643 vs 4479 ± 3235 mg/d); the same observation was noted for renal failure (2.1 ± 0.71 vs 2.8 ± 1.57 mg/dL). Among about 75% of patients in whom mTORi was withdrawn, no injury remained in the medium term whereas among the other 25%, there was a residual injury.</description><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Calcineurin Inhibitors</subject><subject>Creatinine - blood</subject><subject>Drug Substitution</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Graft Rejection - immunology</subject><subject>Graft Rejection - prevention & control</subject><subject>Humans</subject><subject>Immunosuppressive Agents - administration & dosage</subject><subject>Immunosuppressive Agents - adverse effects</subject><subject>Kidney Transplantation - immunology</subject><subject>Medical sciences</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Proteinuria - blood</subject><subject>Proteinuria - chemically induced</subject><subject>Proteinuria - drug therapy</subject><subject>Retrospective Studies</subject><subject>Spain</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Time Factors</subject><subject>Tissue, organ and graft immunology</subject><subject>TOR Serine-Threonine Kinases - antagonists & inhibitors</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. Prostate gland</subject><issn>0041-1345</issn><issn>1873-2623</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkk1v1DAQhi0EotvCX0AREuJCgj_ixOFQVLV8rFQEKkVwsybOhHpJnMV2ivbf42i3AnHCF8v243dGj4aQp4wWjLLq5aaIHlzY-skgdgWnjBW0Kmgp75EVU7XIecXFfbKitGQ5E6U8IschbGg681I8JEecKdFwwVbk2zpkn_wU0brZW8iu8BZ9sO2AL7KzPqLPvtp403n4BUM29dkHGEcYLLjsGvx3jMvdFWxh3BnrsrW7sa2Nkw-vH5EHPQwBHx_2E_Ll7Zvr8_f55cd36_Ozy9yUVRnzGhEbKTmv24ZVUDNRq6aWoDrFpTQo29oo2pZGIJhWlKJrpah7kKY1kja9OCHP97lJx88ZQ9SjDQaHARxOc9BKCZXAqkrkqz1p_BSCx15vvR3B7zSjehGrN_pvsXoRq2mlk9j0-cmhzNyO6e3u653JBDw7ABAMDH0KMjb84cq0RLUEXew5TFJuLXodjEVnsLMeTdTdZP-vn9N_YsxgnU2Vf-AOw2aavUvaNdOBa6o_L6OwTAJjlKom9fsbYaeytw</recordid><startdate>20110701</startdate><enddate>20110701</enddate><creator>Arnau, A</creator><creator>Ruiz, J.C</creator><creator>Rodrigo, E</creator><creator>Quintanar, J.A</creator><creator>Arias, M</creator><general>Elsevier Inc</general><general>Elsevier</general><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>7X8</scope></search><sort><creationdate>20110701</creationdate><title>Is Proteinuria Reversible, After Withdrawal of Mammalian Target of Rapamycin Inhibitors?</title><author>Arnau, A ; Ruiz, J.C ; Rodrigo, E ; Quintanar, J.A ; Arias, M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-7eee955227b916a71378975a8d8255ce5b7c80b4c3eacb343db537fa5cbc509f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Calcineurin Inhibitors</topic><topic>Creatinine - blood</topic><topic>Drug Substitution</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Graft Rejection - immunology</topic><topic>Graft Rejection - prevention & control</topic><topic>Humans</topic><topic>Immunosuppressive Agents - administration & dosage</topic><topic>Immunosuppressive Agents - adverse effects</topic><topic>Kidney Transplantation - immunology</topic><topic>Medical sciences</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Proteinuria - blood</topic><topic>Proteinuria - chemically induced</topic><topic>Proteinuria - drug therapy</topic><topic>Retrospective Studies</topic><topic>Spain</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Time Factors</topic><topic>Tissue, organ and graft immunology</topic><topic>TOR Serine-Threonine Kinases - antagonists & inhibitors</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>Arnau, A</creatorcontrib><creatorcontrib>Ruiz, J.C</creatorcontrib><creatorcontrib>Rodrigo, E</creatorcontrib><creatorcontrib>Quintanar, J.A</creatorcontrib><creatorcontrib>Arias, M</creatorcontrib><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>MEDLINE - Academic</collection><jtitle>Transplantation proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arnau, A</au><au>Ruiz, J.C</au><au>Rodrigo, E</au><au>Quintanar, J.A</au><au>Arias, M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is Proteinuria Reversible, After Withdrawal of Mammalian Target of Rapamycin Inhibitors?</atitle><jtitle>Transplantation proceedings</jtitle><addtitle>Transplant Proc</addtitle><date>2011-07-01</date><risdate>2011</risdate><volume>43</volume><issue>6</issue><spage>2194</spage><epage>2195</epage><pages>2194-2195</pages><issn>0041-1345</issn><eissn>1873-2623</eissn><coden>TRPPA8</coden><abstract>Abstract Conversion to mammalian target of rapamycin inhibitors (mTORi) is an ever more frequent practice in renal transplant recipients, even if it is not always satisfactory, needing to be suspended for various reasons in certain patients. We analyzed the evolution of proteinuria as a marker of kidney damage after withdrawal of mTORi for any reason in order to assess conversion failure risk. Among 1633 renal transplant patients with 185 converted to mTORi, we considered the 52 (28%) who withdrew as result of intolerance or a bad evolution after at least 3 months use (median: 142 days after conversion). Four groups were defined according to the evolution of proteinuria: group 1 (G1), stable after conversion; group 2 (G2), increased with complete recovery (<1 g); group 3 (G3), increased with partial recovery (>1 g); or group 4 (G4), increased without recovery. The evolution according to the groups was: G1 (57.1%), G2 (17.2%), G3 (5.7%), and G4 (20%). There were no differences between the good (G1 and G2) and the bad evolution groups (G3 and G4) in proteinuria at the time of conversion (838 ± 641 vs 532 ± 404 mg/d) or renal function (1.95 ± 0.47 vs 1.90 ± 0.4 mg/dL). Six months after withdrawal, proteinuria was stable in G1 and G2 but worse in G3 and G4 (781 ± 643 vs 4479 ± 3235 mg/d); the same observation was noted for renal failure (2.1 ± 0.71 vs 2.8 ± 1.57 mg/dL). Among about 75% of patients in whom mTORi was withdrawn, no injury remained in the medium term whereas among the other 25%, there was a residual injury.</abstract><cop>Amsterdam</cop><pub>Elsevier Inc</pub><pmid>21839231</pmid><doi>10.1016/j.transproceed.2011.06.045</doi><tpages>2</tpages></addata></record> |
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subjects | Biological and medical sciences Biomarkers - blood Calcineurin Inhibitors Creatinine - blood Drug Substitution Fundamental and applied biological sciences. Psychology Fundamental immunology Graft Rejection - immunology Graft Rejection - prevention & control Humans Immunosuppressive Agents - administration & dosage Immunosuppressive Agents - adverse effects Kidney Transplantation - immunology Medical sciences Nephrology. Urinary tract diseases Proteinuria - blood Proteinuria - chemically induced Proteinuria - drug therapy Retrospective Studies Spain Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Time Factors Tissue, organ and graft immunology TOR Serine-Threonine Kinases - antagonists & inhibitors Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland |
title | Is Proteinuria Reversible, After Withdrawal of Mammalian Target of Rapamycin Inhibitors? |
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