Massive proteinuria (more than 40 gm/24 hr) occurred in a young man almost immediately after renal transplantation with an intrafamilial donor. The proteinuria, accompanied by severe hypoalbuminemia and extensive peripheral edema, persisted for several months and then subsided spontaneously. Histological and immunofluorescent examination of renal tissue showed no evidence of rejection or recurrent nephritis. We attribute the proteinuria to an increase in venous pressure within the kidney caused by ligation of one of two large renal veins draining the donor organ. The spontaneous remission is attributed to the development of adequate collateral venous channels, which acted to relieve the venous hypertension. When a renal homograft has two veins of similar size, both must be used for anastomosis.
Abouna GM, Kogure H, Porter KA, Andres GA, Lutcher CL, Sobel RE. Massive Early Proteinuria Following Renal Homotransplantation. JAMA. 1973;226(6):631-635. doi:10.1001/jama.1973.03230060011004