A high level of urinary retinol-binding protein is associated with cytomegalovirus infection in kidney transplantation

Author(s)

Requiao-Moura, Lucio R. ^{[1, 2]} ; Matos, Ana C. C. ^[2] ; Ozaki, Kikumi S. ^[2] ; Camara, Niels O. S. ^{[3, 1]} ; Pacheco-Silva, Alvaro ^{[1, 2]}

Affiliation

^[1] Univ Fed Sao Paulo, Dept Med, Nephrol Div, Sao Paulo - Brazil

^[2] Hosp Israelita Albert Einstein, Renal Transplantat Div, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Inst Biomed Sci, Dept Immunol, Sao Paulo - Brazil

• Document type: Journal article
• Source: Clinical Science; v. 132, n. 18, p. 2059-2069, SEP 28 2018.
• Web of Science Citations: 0

Abstract

The indirect effects of cytomegalovirus (CMV) viremia can be related to chronic changes in renal allograft structure, but its real impact in early and late graft function remains speculative. A total of 159 patients undergoing renal transplantation using a preemptive therapeutic strategy to prevent CMV disease were included in the present study. The patients were prospectively followed, with serial measurements of urinary retinol-binding protein (uRBP), a marker of proximal tubule injury. uRBP levels and their dynamic performance were compared according to CMV viremia and the 5-year estimated glomerular filtration rate (eGFR), as measured with the modification of diet in renal disease (MDRD) equation. CMV viremia was detected in 79.9% of the patients, with high uRBP levels being detected in 76.0% of these patients (compared with 40.7% in CMV-, P=0.005). High uRBP was associated with male recipients (P=0.02), the number of mismatches (P=0.02) and CMV infection (P=0.001). Five-year eGFR was worse in patients with high uRBP levels (50.3 +/- 25.8 compared with 59.8 +/- 26.4 ml/min, P=0.04). In a multivariate model, eGFR r 60 ml/min was associated with donor age (P<.0.001), the number of mismatches (P=0.04), thymoglobulin dose (P=0.02), the presence of and time with delayed graft function (DGF) (P=0.005 and P=0.04), 1-month tacrolimus levels (P=0.03), and uRBP levels after CMV treatment (P=0.01). Patients with CMV viremia in whom uRBP levels were normalized up to 3 months after treatment showed significantly better 5-year eGFR than those in whom uRBP remained high: 61.0 +/- 24.2 compared with 42.3 +/- 23.9 ml/min, P < 0.001. CMV viremia was associated with high uRBP levels, which represent a profile of proximal tubule injury, and the dynamic performance of uRBP after treatment was associated with long-term kidney graft function. (AU)

• FAPESP's process: 17/05264-7 - Cell metabolism, microbiota and immune system: new paradigms in renal diseases physiopathology
• Grantee: Niels Olsen Saraiva Câmara
• Support Opportunities: Research Projects - Thematic Grants