Prevalence and progression of chronic kidney disease after renal transplantation.

BACKGROUND: We studied the prevalence of chronic kidney disease (CKD) and its progression after kidney transplantation. METHODS: We retrospectively analyzed the evolution of renal graft function, as estimated by the Cockcroft-Gault equation in 567 patients. CKD was classified in accordance with the National Kidney Foundation/Kidney Disease Outcome Quality Initiative with progression estimated by calculating the slope over time. RESULTS: Creatinine clearance (CrCL) at 1 year after transplantation was 57.8 ± 15.5 mL/min with 61.9% patients presenting de novo chronic renal failure. The 1-year-CrCl provided the best correlation with the 3-year CrCl (R(2) = 0.58; P < .001). Medians of slope (MS) among all patients was -2.38 ± 5.7 mL/min/y (-11.9 mL/min over 5 years). Patients who reached a CrCl < 60 at 1 year after transplantation showed a MS of -3.92 ± 6.5, while the others, -2.03 ± 5.2 mL/min/y (P = .046). Similarly, patients who reached a CrCL < 60 at 3 years after transplantation displayed a MS of -1.49 ± 3.5 mL/min/y, while the others, 0.62 ± 3.0 mL/min/y (P < .001). CONCLUSIONS: The majority of renal transplant patients present de novo chronic renal failure already at 1 year posttransplantation. The rate of graft functional deterioration was 2.38 mL/min/y. It was worse among patients who displayed a CrCL less than 60 mL/min both at 1 and at 3 years. One-year CrCL was a good marker for 3-year CrCL.

High expression of Tim-3 mRNA in urinary cells from kidney transplant recipients with acute rejection.

TIM-3 is a recently described molecule specifically expressed on Th1 differentiated T cells. We explored the usefulness of urinary mRNA profiles in the diagnosis of renal acute rejection (AR). Sixty urinary samples from renal transplant recipients simultaneously collected to allograft biopsy, (AR = 30 and No-AR =30), and 12 urinary samples from stable renal transplants were analyzed. Urinary mRNA encoding for TIM-3 and IFN-gamma were quantified using real time RT-PCR. TIM-3 mRNA was highly expressed in AR (559.19 +/- 644.41) compared to No-AR (3.78 +/- 7.20), and stable transplants (0.54 +/- 0.76), p < 0.001. To a lesser degree, IFN-gamma mRNA transcripts were also increased in AR (50.40 +/- 38.71), compared with No-AR (4.69 +/- 12.62), and stable transplants (0.38 +/- 0.44) p < 0.001. The highest expression of TIM-3 in AR makes it a promising noninvasive test for its diagnosis.