PROTEINURIA IN LONG-TERM RENAL-TRANSPLANT RECIPIENTS TREATED WITH AZATHIOPRINE OR CYCLOSPORINE

Persistent proteinuria after renal transplantation (RT) usually is rel ated to an unfavorable prognosis. One cause is the chronic toxicity of cyclosporine (CsA). The individual tolerance against CsA is very diff erent and a histologic discrimination from other causes of chronic gra ft dysfunction is rather difficult. Methods: We examined renal functio n and urinary proteins (Igc, albumin and alpha(1)-microglobulin) by hi ghly sensitive immunoluminometric assays in long-term renal transplant recipients, who were treated with azathioprine and prednisolone (n = 10, 11,6 years after RT) or with CsA alone (n = 12, 7,25 years after R T). Results: alpha(1)-microglobulin, albumin in urine (p < 0,05) and s erumcreatinine (p < 0,01) were lower in azathioprine-treated patients, compared to CsA-treated patients. 8/10 of the azathioprine patients h ad a normal proteinuria, while 9/12 of the CsA patients had albuminuri a (p < 0,05), 6/12 IgG-uria and 8/12 tubular proteinuria (p < 0,01) in pathologic ranges. Creatinine clearances were lower in the CsA group (p < 0,01). Conclusion: Long-term renal transplant recipients treated with cyclosporine had a worse renal function and a pathologic proteinu ria compared to patients treated with azathioprine.