COMPLICATIONS - METABOLIC

D. Sharma
Nephrology, command hospital, panchkula/INDIA

Body: Post Renal Transplant Proteinuria-an Indian study
Deepak Sharma#,
#Dept of Nephrology,Medical Division,Command Hospital(Chandimandir), PANCHKULA,India Introduction- Proteinuria is quite common ,occurring in upto 50% of patients, resulting in decreased patient and allograft survival and increased prevalence cardiovascular disease. ACE inhibitors(ACEI) & Angiotensin receptor blockers(ARB) have been the mainstay of therapy in native kidney proteinuria,though may not succeed in all patients because of side effects..Pentoxyfylline has been advocated as an anti-inflammatory measure,probably contributing to amelioration of proteinuria.
Aim-To study the effects of Telmisartan,Ramipril & Pentoxyfylline on Proteinuria in Renal transplant recipients.
Methods- A total of 72 Renal transplant recipients having proteinuria of 300 mg/24hr or more with stable GFR of 42ml/min to 70ml/min were studied from Sep 2006 to Sept 2009 at a tertiary care nephrology centre. The patients in groupA (total 51 received Ramipril,Telmisartan for six months & Pentoxifylline was added due to persistence of significant proteinuria.In 11 patients receiving Ramipril(groupB) Pentoxifylline was added due to persistence of proteinuria beyond six months. 10 patients (Group C)were given Telmisartan alone for six months & then received Pentoxifylline in addition for another three months. Results- In group A proteinuria (p=0.001),albuminuria(p=0.005) & urinary albumin to creatinine ratio(ACR,P=0.005) declined& serum potassium(p=0.95) did not increase significantly.In group B proteinuria(p=0.015) , ,albuminuria(p=0.001)& ACR(0.019) decreased & there was no(p=0.78) significant elevation in potassium.In serum groupC proteinuria(p=0.017),albuminuria(p=0.011)& ACR(P=0.007) decreased significantly& there was no(p=0.98) significant elevation in serum potassium.Serum creatinine in all the groups was (p=0.030)stable.GFR correlated positively with changes in albuminuria which in turn correlated negatively(p=0.005) with serum creatinine.Changes in ACR correlated negatively with serum creatinine(p=0.020) in all groups.
Conclusion-The present study reveals the benefit of using Pentoxifylline in combination with ACEI&ARB resulting in significant decline of proteinuria,albuminuria & improvement of GFR especially in patients having persistence of proteinuria despite using ACEI &/orARB.There was no significant hyperkalemia noted in this study. All the drugs(Ramipril,Telmisartan& Pentoxifylline) were well tolerated.

Disclosure: All authors have declared no conflicts of interest.