Proteinuria Among Renal Transplant Patients and Its Relation to Hepatitis C Virus and Graft Outcome: A Single Center Experience

Objectives: Chronic hepatitis C virus has been associated with glomerular disease in native and transplanted kidneys. Reports suggest that hepatitis C virus-infected renal recipients may develop de nova glomerulonephritis. We evaluated the presence of hepatitis C virus at transplant, the occurrence of proteinuria in Egyptian renal transplant patients, and its possible link with graft survival. Materials and Methods: Three hundred seventeen patients with end-stage renal disease receiving transplants in Mansoura Urology and Nephrology Center were retrospectively evaluated between 2000 and 2003. Their sera were assayed for anti-hepatitis C virus-antibodies at transplant. The relation between hepatitis C virus and development of posttransplant proteinuria was evaluated, along with possible effects of proteinuria on long-term graft survival. Results: Two hundred seventy-three recipients fulfilled the inclusion criteria, 169 were positive and 104 were negative for hepatitis C virus-antibodies by ELISA. Mean duration of posttransplant follow-up was 87.73 +/- 26.79 and 84.29 +/- 28.55 months for both groups. Groups were comparable regarding the incidence and quantity of hepatitis C virus-positive patients and 0.4 grams/day (P = .09 of proteinuria). In both hepatitis C virus-positive and negative groups, those with nephrotic range proteinuria showed worse graft survival (P = .001) and higher frequency of chronic allograft nephropathy (P = .05) compared with nonproteinuric patients. Conclusions: There is a high prevalence of hepatitis C virus in our end-stage renal disease patients awaiting renal transplant. The incidence and quantity of proteinuria is similar in both hepatitis C virus-positive and hepatitis C virus-negative transplant recipients. Nephrotic range proteinuria is associated significantly with a higher incidence of chronic allograft nephropathy. Independent from serology, it is associated with poorer graft outcome.