INFLUENCE OF STEROID WITHDRAWAL ON PROTEINURIA IN RENAL-ALLOGRAFT RECIPIENTS

The ratio of urine protein/urine creatinine in spot urine specimens wa s measured to determine the influence of steroid withdrawal and other clinical variables on urinary protein excretion in 135 primary renal t ransplant recipients, including 73 patients in whom steroid withdrawal was never attempted and 62 patients in whom steroid withdrawal was at tempted at various times following transplantation. Both univariate an d multivariate analyses showed that steroid withdrawal per se did not directly influence proteinuria. However, patients who renewed steroid therapy because of acute allograft rejection following attempted stero id withdrawal exhibited significantly more proteinuria than was encoun tered either in patients who remained steroid-free or in those for who m steroid withdrawal was never attempted. This study suggests that ste roid withdrawal itself does not lead to proteinuria, however, acute re jection following steroid withdrawal clearly accelerates urinary prote in excretion that may be the harbinger of chronic allograft rejection.