Proteinuria following a switch from calcineurin inhibitors to sirolimus

Background. Sirolimus is an alternative option for kidney transplant patients treated with calcineurin inhibitors (CNI) when renal function is deteriorating. However, the incidence of proteinuria following a switch from CNI to sirolimus has caused concern, and was therefore investigated here. Methods. In a retrospective study, 68 renal transplant recipients were switched from CNI to sirolimus. Proteinuria was measured using 24-hour urine collection before the switch and collections 3, 6), 12, and 24 months thereafter. In addition, proteinuria was measured in patients who had to be switched back to CNI due to side effects. Survival analyses were performed. Results. Baseline proteinuria was 0.39 +/- 0.69 g/day in all 68 patients. It increased to a mean 1.44 +/- 1.90 g/day at 3 months (P<0.001) and remained elevated at 6, 12 and 24 months. When sirolimus was withdrawn after the CNI-sirolimus switch for 19 patients, proteinuria decreased from 1.95 +/- 2.06 g/day to 0.9 +/- 1.4 g/day (P<0.05). Proteinuria above 0.3 g/day before the CNI-sirolimus switch correlated significantly with the decrease of renal function thereafter. Conclusion. CNI-treated kidney transplant recipients may develop reversible proteinuria when switched to sirolimus.