Proteinuria after Kidney Transplantation: Evaluation and Management

Abstract Purpose of Review Proteinuria is a post-kidney transplant complication associated with adverse patient and graft outcomes. While proteinuria guidelines in non-transplant chronic kidney disease have adapted to emerging evidence, similar guidelines in transplantation ought to as well. Recent Findings Recent evidence suggests that quantifiable albuminuria, even in patients without detectable proteinuria significantly impacts kidney transplant recipients, increasing odds of graft failure 25-fold, all-cause mortality nearly 5-fold, cardiovascular mortality nearly 7-fold, and malignancy-related mortality more than 8-fold. Such data along with the contemporary paradigm shift in field-changing anti-proteinuric therapeutics have prompted this examination of post-transplant proteinuria. Summary In this review, we aim to refine current understanding of post-transplant proteinuria as well as highlight key broad strategies beyond rejection applicable to the broader audience of nephrologists involved in the care of kidney transplant recipients.