Evaluation of Proteinuria in the New Era of Immunosuppression

• Proteinuria is an important marker for graft and patient survival.• Screening for proteinuria is the key for early recognition and management of most of renal disease and the level of proteinuria in an important marker for the progression of kidney disease.• Persistent proteinuria after kidney transplantation has been attributed to chronic rejection, recurrent or de novo glomerulopathy, glomerulonephritis, diabetes mellitus, and chronic and acute rejection. So it so important to highlight the risk factors, the incidence, impact and the treatment of this complication.• Immunossuppresive drugs given after transplantation have an important role in appearance or progression of post kidney transplantation proteinuria and careful tailoring of the immunossuppresives protocol will decrease the possibilities for progression of proteinuria.• Calcineurin blockade is associated with nephrotoxicity and hypertension. Because renal function and blood pressure control are important predictors of graft survival, new immunosuppressive drugs such as mammalian target of rapamycin (mToR) inhibitors have been considered as a substitute for cyclosporine (CsA) and tacrolimus. In addition, they may prevent arteriolar hyalinosis, glomerulosclerosis