Evidence map›Paper›PMID 42234598›Full record

ArticleAmerican journal of nephrology2026

Beyond the Amount: The Selectivity of Proteinuria and Risk of Graft Failure in Kidney Transplant Recipients.

Firas F Alkaff, Wendy A Dam, Jenny E Kootstra-Ros, Eva Corpeleijn, Mohamed R Daha, Martin H de Borst, Jacob van den Born, Stephan J L Bakker, Stefan P Berger

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Article in American journal of nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Firas F AlkaffDivision of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, f.f.alkaff@umcg.nl; firasfarisialkaff@fk.unair.ac.id.
Wendy A DamDivision of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jenny E Kootstra-RosDepartment of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Eva CorpeleijnDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Mohamed R DahaDivision of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Martin H de BorstDivision of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jacob van den BornDivision of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Stephan J L BakkerDivision of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Stefan P BergerDivision of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPatients with nonselective proteinuria generally have a worse prognosis than those with selective proteinuria. However, this has never been studied in kidney transplant recipients (KTRs). This study aimed to evaluate the association between proteinuria selectivity and graft failure among KTRs.

methodsWe used data from KTRs with a functioning graft ≥1 year after transplantation who enrolled in the prospective TransplantLines Food and Nutrition Biobank and Cohort Study and had urinary albumin excretion ≥30 mg/24-h and urinary protein excretion >150 mg/24-h. The selectivity of proteinuria was based on the clearance ratio of IgG to albumin (≤0.10 = highly selective; >0.10 = moderate/nonselective). Multivariable Cox regression analyses were performed to evaluate the association between proteinuria selectivity and graft failure.

resultsA total of 335 KTRs (36% female, median 6 years after transplantation, mean estimated glomerular filtration rate [eGFR] 47 mL/min/1.73 m2) were included in the analyses. Of them, 107 (31.9%) had moderate/nonselective proteinuria. KTRs with moderate/nonselective proteinuria had lower eGFR, higher 24-h urinary protein excretion, and higher levels of tubular injury markers. During a median follow-up of 5.2 years after baseline measurement, 66 (19.7%) KTRs developed death-censored graft failure. Moderate/nonselective proteinuria was significantly associated with a higher risk of graft failure, independent of potential confounders, including eGFR and 24-h urinary protein excretion (adjusted hazard ratio [95% confidence interval] = 2.10 [1.12-3.94], p = 0.020).

conclusionThe independent association between proteinuria selectivity and graft failure highlights the importance of evaluating proteinuria selectivity, in addition to urinary protein, in routine clinical care for KTRs.

Indexed as

BiomarkerGraft failureKidney transplantationsProteinuria

Identifiers

PMID42234598
PMCPMC13432932

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