Friday, September 23, 2011

Topic Discussion: Diabetic Nephropathy Post Kidney Transplantation

Post Transplant Porteinuria: Differential Diagnosis:
1. Recurrent Glomerular Disease
2. Denovo Glomerular Disease
3. Antibody Mediated Rejection
4. Infection from CMV or Adenovirus
5. Collapsing Glomerulopathy
6. Thrombotic Microangiopathy
7. Diabetic Nephropathy

What is the data and incidence on Diabetic Nephropathy Post transplant? 

80-100% of diabetics who undergo transplant will have histological changes of diabetic nephropathy, which may be seen within 6 years. Diabetic nephropathy is not believed to be a significant cause of allograft failure, but has not been well-studied. 

One study that looked at a 5 year prospective trial of 48 pts with type-1 DM underwent renal transplant 
Patients were randomized to intensive or standard insulin therapy (insulin several times per day/continuous vs 1-2 times daily); statistically significant difference in A1C maintained . The five year  post-transplant biopsy showed standard group had 2x increased volume of mesangial matrix (p=0.024) and 3x increase in arteriolar hyalinosis, wider basement membrane(p < 0.10). 
Understudied disease but by far the MOST common cause of proteinuria years following a kidney transplantation.

Post by Prasanth Krish, MD
Renal Fellow, Hofstra NSLIJ


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