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Protocol biopsy studies suggest that glomerulosclerosis is a significant contributor to long\u2010term graft failure. We previously demonstrated that podocyte loss in the first year post\u2010transplantation predicted long\u2010term allograft survival. However, whether increased podocyte loss continues over the lifespan of a KT remains unclear. We performed a cross\u2010sectional analysis of 1182 urine samples from 260 KT recipients up to 19\u2010years after transplantation. Urine pellet (UP) mRNAs were assayed for podocyte (NPHS2\/podocin and nephrin\/NPHS1), distal tubule (aquaporin2), and profibrotic cytokine (TGFbeta1). Multivariable generalized estimating equations were used to obtain \u201cpopulation\u2010averaged\u201d effects for these markers over time post\u2010KT. Consistent with early stresses both podocyte and tubular markers increased immediately post\u2010KT. However, only podocyte markers continued to increase long\u2010term. A role for hypertrophic stresses in driving podocyte loss over time is implied by their association with donor BMI, recipient BMI, and donor\u2010recipient BMI mismatch at transplantation. Furthermore, UP podocin mRNA was associated with urine TGFbeta1, proteinuria, and reduced estimated glomerular filtration rate, thereby linking podocyte injury to allograft fibrosis and survival. In conclusion we observed that podocyte loss continues long\u2010term post\u2010KT suggesting an important role in driving late graft loss.<\/jats:p>","DOI":"10.1111\/ctr.14457","type":"journal-article","created":{"date-parts":[[2021,8,13]],"date-time":"2021-08-13T13:52:25Z","timestamp":1628862745000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Urine marker analysis identifies evidence for persistent glomerular podocyte injury across allograft lifespan"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1602-9425","authenticated-orcid":false,"given":"Abhijit S.","family":"Naik","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad","family":"Aqeel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Q","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahboob","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"He","sequence":"additional","affiliation":[{"name":"Department of Biostatistics University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger C.","family":"Wiggins","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Michigan  Ann Arbor Michigan 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