The incidence of thrombovenous and thromboembolic complications in kidney transplant patients with recurrent glomerulonephritis is dependent on the occurrence of severe proteinuria

Background: Patients with recurrent glomerulonephritis (RG) after kidney tr ansplantation are at high risk fdr thromboembolic events but it is unclear when the risk begins to increase. Patients and methods: We evaluated the ri sk for thrombovenous and thromboembolic complications in relation to the oc currence of severe proteinuria (greater than or equal to 2 g protein in 24- hour urine) in 15 renal allograft recipients with biopsy-proven RG, who had received 20 allografts RG. The total period of observation was 53 (10 - 91 ) months. The post-transplant period before the occurrence of severe protei nuria lasted 18 (1 - 34) months and the subsequent proteinuric period until the end of the study, 35 (9 - 85) months. Results: The monthly incidence o f thrombovenous and thromboembolic complications was only 1/18 in the first period before and in contrast, 11/35 in the subsequent period after the oc currence of severe proteinuria. The mean urinary protein excretion increase d from 0.4 +/- 0.1 g/day immediately after transplantation to 6.1 +/- 4.8 g /day at the end of the study (p < 0.001). During the same period there was a 1.2-fold increase of fibrinogen (from 366 +/- 88 to 442 +/- 120 mg/dl, p < 0.025) and a 1.2-fold decrease of antithrombin III (from 110 +/- 12 to 92 +/- 12%, p < 0.001). All thrombotic complications occurred in 6 patients w ith 9 grafts; at the end of the study this group showed higher fibrinogen c oncentrations (454 +/- 155 versus 433 +/- 89 mg/dl, NS) and lower antithrom bin III levels (88 +/- 11 versus 97 +/- 11%, p < 0.05) than the group witho ut thrombotic complications. Conclusion: In kidney transplant patients with RG a high risk for thrombovenous and thromboembolic complications can be o bserved after the occurrence of severe proteinuria; this can mainly be expl ained by high fibrinogen and low antithrombin III levels. Anticoagulation t herapy should be started in patients with RG immediately after the occurren ce of severe proteinuria.