1.  Title: POST RENAL TRANSPLANT DIABETIC NEPHROPATHY By:Ayman Maher Nagib, Yasser Elsayed Matter, Mohamed Megahed Aboulmagd, Osama Ashry Gheith, Ayman Fathy Refaie, Mohamed Ahmed Ghoneim, From: Dept. of dialysis and transplantation, The Urology Nephrology Center, Mansoura University, Egypt.
  Clinical, Kidney, Metabolic complications
P432
Introduction
Results
Diabetic nephropathy occurs in type 1 and type 2 diabetes mellitus, and in other secondary forms of diabetes mellitus, for example after pancreatitis or pancreatectomy, in which duration of diabetes is long-enough and level of glycaemia high enough to result in complications. Hence post-transplant diabetes mellitus firstly reported in 1960s, meanwhile case reports of recurrent and de novo diabetic nephropathy post kidney transplantation were reported in the early 2000s mostly due to same risk and precipitating factors of the diabetic nephropathy in non-transplant population and may appears early in view of the hyperfiltration risk of being, single, grafted kidney.
As early hyperglycaemia development is a strong predictor for PTDM, prompt intervention is needed. When PTDM develops, monitoring and control of blood glucose profile, lipid profile, microalbuminuria, diabetic complications and comorbid conditions is recommended. Immunosuppressive regimen modification may be considered as suggested by KDIGO guideline to reverse or to improve the diabetes after weighing the risk of rejection and other potential adverse effects. Strategies for modifying immunosuppressive agents include dose reduction, discontinuation, and selection of calcineurin inhibitor, anti-metabolite agents[3].
Objectives
In this review we tried to discuss the risk factors specially genetics risks, early detection, strategies to avoid and delay the progression of this de novo and recurrence diabetic nephropathy.
Pathways involved in the development of diabetic kidney disease
Methods
Conclusion
We reviewed many articles discussing the post transplant diabetes and diabetic nephropathy specially genetic background trying to analyze this important metabolic complication post transplantation and hence hinder its progression and management.
We concluded that de novo and recurrent diabetic nephropathy post kidney transplant is not a rare complication and must be minded to tailor immunosuppression especially the benefit from pharmacogenetics of tacrolimus to suspect which recipient is vulnerable to post transplant diabetes. Lifestyle modification and tight control of blood glucose can delay its occurrence as early introduction of ACEI /ARBS.
Results
Proteinuria developing within 3-6 months after trans­plantation is a strong risk factor for PTDM. Low-grade (<1 g/day) and very low-grade (<0.3 g/day) proteinuria are independent risk factors for PTDM [1]. Lifestyle modifications in combination with less diabetogenic immunosuppressants can conceivably decrease incidence of PTDM. If the incidence of PTDM can be reduced, patients, providers, private insurers, and federal programs such as Medicare and Medicaid may all stand to benefit. If successful, lifestyle intervention might ultimately improve quality of life, morbidity, and mortality for transplant recipients and lengthen the life span of the transplanted kidney, and the cost of caring for patients with kidney transplants might also be reduced. [2]
References
. Roland M,et al., Early pulse pressure and low-grade proteinuria as independent long-term risk factors for new-onset diabetes mellitus after kidney transplantation. Am J Transplant 2008.
2. Chakkera HA,et al., Can New-Onset Diabetes After Kidney Transplant Be Prevented? Diabetes Care 2013;.
3. M. Juan Khong, Ch. Ping Chong. Prevention and management of new-onset of DM in kidney transplantation. The Netherland journal of medicine 2014.