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It is usually mild and predominantly of tubular origin and is caused mainly by rejection, mTOR inhibitors, or hypertension; however, proteinuria could also be in the nephrotic range and of glomerular origin if caused by the recurrence of idiopathic FSGS or rejection. Proteinuria is a risk factor impacting graft and patient survival in adults and graft survival in children. Proteinuria should be assessed by protein\/creatinine ratio regularly in pediatric kidney transplant recipients. In children with idiopathic FSGS, proteinuria should be assessed daily during the first 2\u20133\u2009weeks post\u2010transplant to enable prompt diagnosis of recurrence. The etiology of proteinuria should be identified (recurrence, rejection, mTOR\u2010inhibitors, hypertension, etc.). If no apparent cause is found, a graft biopsy should be considered. Antiproteinuric therapy is primarily focused on treating the causes of the proteinuria, and this is usually done using Angiotensin\u2010converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs). The long\u2010term follow\u2010up goal should be normalization of proteinuria with a protein\/creatinine ratio &lt;\u200920\u2009mg\/mmol (200 mg\/g). Because of the role elevated blood pressure may play in exacerbating proteinuria, antihypertensive medications should be used in those who are resistant to initial antiproteinuric therapy to achieve lower BP.<\/jats:p>","DOI":"10.1111\/petr.70233","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T04:35:16Z","timestamp":1764045316000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Proteinuria After Kidney Transplantation"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1371-3096","authenticated-orcid":false,"given":"Tomas","family":"Seeman","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Second Faculty of Medicine Charles University  Prague Czechia"},{"name":"Department of Pediatrics University Hospital Ostrava and Medical Faculty University of Ostrava  Ostrava Czechia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6441-8612","authenticated-orcid":false,"given":"Robert L.","family":"Myette","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute &amp; Children's Hospital of Eastern Ontario, Division of Pediatric Nephrology University of Ottawa  Ottawa Ontario Canada"},{"name":"Kidney Research Center, Ottawa Hospital Research Institute University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3687-6691","authenticated-orcid":false,"given":"Janusz","family":"Feber","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University Hospital Ostrava and Medical Faculty University of Ostrava  Ostrava Czechia"},{"name":"Children's Hospital of Eastern Ontario Research Institute &amp; Children's Hospital of Eastern Ontario, Division of Pediatric Nephrology University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5861-4505","authenticated-orcid":false,"given":"Massimiliano","family":"Bertacchi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology, Department of Pediatrics, Gynecology and Obstetrics Geneva University Hospitals  Geneva Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5629-6520","authenticated-orcid":false,"given":"Raja Sekhar","family":"Dandamudi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Nephrology Washington University in St. Louis School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniella Levy","family":"Erez","sequence":"additional","affiliation":[{"name":"Schneider Children's Medical Center  Petach Tiqva Israel"},{"name":"Faculty of Health Sciences Tel Aviv University  Tel Aviv Israel"},{"name":"Children's Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Buescher","sequence":"additional","affiliation":[{"name":"Department of Pediatrics II, University Hospital of Essen University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"e_1_2_21_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)09260-4"},{"key":"e_1_2_21_3_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.01780408"},{"key":"e_1_2_21_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2012.42"},{"key":"e_1_2_21_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200108150-00014"},{"key":"e_1_2_21_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-024-03804-7"},{"key":"e_1_2_21_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02834.x"},{"key":"e_1_2_21_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-198412000-00012"},{"key":"e_1_2_21_9_1","first-page":"1235","article-title":"Proteinuria in Renal Transplant Recipients: Incidence, Cause, Prognostic Importance","volume":"20","author":"Bear R. 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