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Free Content Sirolimus-Associated Heavy Proteinuria in a Renal Transplant Recipient: Evidence for a Tubular Mechanism

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Sirolimus is a new and potent immunosuppressive agent. Recently, increased proteinuria has been recognized as an important complication. However, the mechanism thereof has remained unclear. We describe a patient who received sirolimus as standard therapy after living donor kidney transplantation. Within 10 days the patient developed a severe proteinuria that disappeared completely after substituting tacrolimus for sirolimus. Renal biopsy disclosed normal glomeruli even without effacement of the podocytic foot processes. Using FITC labeled anti-albumin antibodies we noted complete absence of albumin in the proximal tubules, whereas an abundant albumin staining was observed in a control patient with a comparable level of proteinuria due to a recurrence of focal segmental glomerulosclerosis after transplantation. Our data suggest that sirolimus can induce severe proteinuria, and that reduced tubular protein reabsorption contributes to the protein loss.
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Keywords: Proteinuria; reprotoxicity; sirolimus; transplantation

Document Type: Research Article

Affiliations: 1: Department of Nephrology 2: Department of Pathology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

Publication date: 01 February 2006

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