Protein/creatinine ratio increased

[valexzhou]

Hi, I am 14months from my transplant, really enjoyed and have been carefully taken care of the priceless gift, for the past 14 months, all the numbers look fine until last months my urine test returns that my protein/creatinine ratio was 287mg/dl (normal range 0-200), today I visited my post transplant doctor and discussed this, he mentioned if the number is below 300 should be fine even though I was 89mg/dl in the summer. Anyhow, he asked me to get urine test right after the appointment, the result returned back was 407mg/dl a few mins ago... I am panicking now.. will follow up doc tomorrow, but wanted to check if there are anyone here had the similar experience and anything you can share?

Thank you!!!

[LisaSnow]

What medications are you on? Sirolimus and some others are known to have side effects including proteinuria. That is normal and not an indication of kidney issue.

[valexzhou in reply to LisaSnow]

Thanks Lisa! I am having Nulojix(belatacept) infusion every 4 weeks since Apr along with Myfortic, and post transplant was with tacrolimus.

[LisaSnow in reply to valexzhou]

Has your creatinine or GFR changed?

[valexzhou in reply to LisaSnow]

Thanks LisaSnow, I had my lab for the blood yesterday, so wait to see the result on Monday. But for the past from 89 to 287, my creatinine level wasn’t changed, so will see on Monday, will share.

[Balap in reply to valexzhou]

what is the reason for conversion? tacrolimus is a very good medicine

[valexzhou in reply to Balap]

Thanks for replying, my transplant was from mom and her size is relatively smaller than me so the doc suggested the change to get better long term outcome and better creatinine level. It actually did bring down the creatinine level after the change.

[Balap in reply to valexzhou]

if you don't mind what is the creatinine level before and after change

[valexzhou in reply to Balap]

2.02-2.2 to 1.5-1.6

[valexzhou in reply to valexzhou]

Just got my lab result from last Friday- my creatinine is 1.45.

[LisaSnow in reply to valexzhou]

excellent number! I don't think you have too much to worry about.

[AndrewT]

Dear valexzhou,

Don't 'Panic' too much, about 'Strange' results, so soon after Transplant. The reason that 'they' keep such a close 'Eye On You'... is for just this Reason! The Chances Of Rejection, is a 'Reverse Parabola'... in other words it reduces, the greatly with time.

You are, a little, over a year- at the Stage where 'Things' are Settling Down BUT 'Odd Blips' Do Happen. Have 'They' changed any Medication recently (within the last few months).

Two 'things' Do speak to your Transplant Team and Don't Panic! Let us know how you Get On, will you valexzhou?

Kindest Wishes

AndrewT

[valexzhou in reply to AndrewT]

Thanks AndrewT!! I did spoke with my post transplant coordinator who also talked to my post transplant doctor, he suggested to monitor a few more measurement (every 2 weeks for lab test), then may change my HBP medication to Lisinopril from Amlodipine to help the situation.

Meanwhile, there was a talk with him when I visited him, he also mentioned since my kidney disease was caused by IgA, so definitely there will be IgA deposit in the transplant kidney, but he don’t anticipate it will reoccurs as the chance is very low with low does of prednisone.

In term of medication changes, in the last 6 months, the only change is the myfortic, I was asked to increase 1 more pill in the night as they saw my WBC is around 7.3 in the summer time. But now with the change it went down to 3.8 two weeks ago.

Seems I only can wait and see, and pray.. will share any updates.

Thank you again!

[Slcallat in reply to AndrewT]

Totally agree with the above reply...The first year of transplant was the worse emotionally. I panicked over every lab result. I soon learned to take each day at a time and to accept that I can control Only what I can, and the rest will take care of itself. LIVE in the moment, minute, hour, day and enjoy each and everyday you are Blessed to Have. I hope you have, cherished, and enjoy your kidney as I did. Bless your Mother! That’s Love. Take Care and Be Safe😊

[valexzhou in reply to Slcallat]

Thank you!!

[Balap]

I'm sorry to hear your protein loss.

protein/creatinine ratio or PCR is not represented by mg/dL

usually they suffix mg/mmol or mg/gm or nothing

check your report.

spot urine Protein is usually represented in mg/dL

> normal values are 0 to 20 mg/dL

> 20 and 200mg is called microalbuminuria

> above 200mg is called proteinuria

Besides PCR, protein in 24hrs urine is a very good test, which tells you how much protein is lost per day

[valexzhou in reply to Balap]

Sorry my bad, it was represented as mg/g creat in my report. And my spot protein in urine is 9mg/dl. The dipstick test is negative.

[Balap in reply to valexzhou]

Protein 9mg/dl is normal (normal values are 0 to 20 mg/dL )

[valexzhou in reply to Balap]

Yes, all my dipstick test is negative for protein. But the protein/creatinine ratio gave me hard time. I guess I drink too much water everyday (4-5l) which bring down the the urine concentration and the urine protein level. but the truth is reflected in the pro/creatinine ratio report.

[Balap in reply to valexzhou]

to reduce protein leak, Blood Pressure is controlled and must be below 130/80

. some times, BP medicines are given (ACEIs or ARBs). Above BP medicines can temporarily increase creatinine and potassium. ACEIs can reduce Hb

[-8754 in reply to valexzhou]

I’m 1.6 years post TP all numbers good. However, I have learned that like sugar, protein intake must be controlled! Remember, it is easy Post TP (for me anyway) to sometimes let my guard down because I now feel normal again. It is never good to have significant protein in your urine. I am told by my Nephrologist that there will always be “trace amounts” of protein in TP patients. Good luck!

[valexzhou in reply to -8754]

Thank you!

[sujay1991]

Hello , I know this has been posted a year ago but I am in the same boat as you . I am 15 month post transplant and I am also having protein creatinine ratio to be between 200-300 mg/g . May I know what your doctors advised and what if any suggestions you have for me ? I am also freaking out . Hoping to hear back soon . Thank you.

[Dna4christ]

what was the outcome if I may ask?? I am also in the same situation right now- 526mg

[valexzhou in reply to Dna4christ]

It has been a long time for this post, and the protein level has been swinging since then, net net, it was caused by the IgA reoccurrence, and after 2 years, had biopsy to confirm it, then with some adjustment to medication, now the protein seems under control, last couple tests were around 300, one big thing I learnt through this is, don’t panic, follow up with the medic team and eat health, focus on things you can control…

[valexzhou in reply to valexzhou]

enjoy the gift and the life..take care!

[Dna4christ in reply to valexzhou]

thank you so much!! I am trying to do that right now. No stress. No panic. Eat what I can and enjoy my life loving myself ! Thanks again for your response!