Avaliação da expressão proteica de nefrina em vesículas extracelulares urinárias de pacientes no pós-transplante renal

Abstract

Introduction: Renal transplantation (KTx) is one of the main treatments for chronic kidney disease (CKD) in terminal stage. However, some factors can cause the appearance of albuminuria and consequent negative impact on graft survival, which can interfere with the prognosis of post-KTx patients. The albumin/creatinine ratio (ACR) measures albuminuria, but this marker is not specific for glomerular damage. Thus, the study aimed to evaluate the protein expression of nephrin in urinary extracellular vesicles (uEVs) in post-KTx patients. Methods: Forty-seven patients were recruited in their first KTx treated at the nephrology clinic of a university hospital. Patients were followed for 3,6,9 and 12 months post KTx. Data from medical history, blood and urine samples were collected at follow-up times. Results: The renal function parameters of the patients - ACR, creatinine and estimated glomerular filtration rate (eGFR) - showed no significant changes (p> 0.05). Increased values of nephrin [3 (p=0.004) and 6 months (p=0.009)] were found. Regarding the ACR assessment, a significant increase was observed in the times of 9- (9 months x 3 months: p = 0.002; 9 months x 6 months: 0.001) and 12 months (12 months x 3 months: p <0.001; 12 months x 6 months: 0.001) when compared to 3 and 6 months, respectively. Conclusion: This study showed that increased nephrin expression in uEVs may represent an important indicator of glomerular damage, being a good predictor of albuminuria and decline in eGFR in the post- KTx.