Pregnancy in renal transplant patients: Renal function markers and maternal–fetal outcomes

Introduction Progressive proteinuria and glomerulosclerosis characterize chronic allograft nephropathy. Podocytes are fundamental cells for maintaining the functionality of glomerular filtration barrier. Failure to achieve this task due to reduced podocyte number and results in progressive glomerular dysfunction, causing proteinuria and glomerulosclerosis and ultimately leading to end-stage kidney disease. Assessment of podocyturia and its correlation with other renal parameters could help with the diagnosis and definition of prognosis of the glomerulopathies, thus contributing to risk reduction. Objective To evaluate podocyturia and others renal parameters as functional markers in pregnant women with kidney grafts. Methods In this cross-sectional and prospective study, 43 pregnant women with kidney grafts had their Mid-stream urine samples collected to determine proteinuria, including retinol-binding protein (enzyme immunoassay using monoclonalantibodies), albumin/creatinine ratio (immunoturbidimetry), protein/creatinine ratio (the alkaline picrate colorimetric method), and podocyturia (indirect immunofluorescence). Results 43 women who got pregnant after renal transplantation were included. Podocyturia was not significantly correlated with other renal function markers. A gradual increase was observed in the following parameters during pregnancy and puerperium: serum creatinine levels (P Conclusion Proteinuria, urinary protein/creatinine ratio, and retinol-binding protein levels were elevated in patients with preeclampsia. Proteinuria (or more specifically, urinary protein/creatinine ratio) and albumin/creatinine ratio has also used as a marker of CKD progression. We observed that urinary podocyte excretion occurs in pregnant women with kidney transplant. Using these markers to assess renal function during pregnancy may be clinically useful for early diagnosis and follow-up of glomerular injury, eventually preeclampsia. It may be also associated to its severity or activity.