Excretion of urinary proteins as predictors of early posttransplantation complications and late renal allograft failure
Year: 2005
Type: dissertation
Study design: Observational Study
Abstract: Acute graft rejection (AR) and chronic allograft dysfunction (CAD) are the two most common causes of renal transplant failure.Their early detection is crucial for the adequate treatment and outcome.In order to find out noninvasive markers of AR or other early posttransplantation complications and potential indicators of the developing of CAD, urinary excretions of α1M, IL-1β, IL-1ra and sICAM-1 were measured in 137 renal graft recipients within the first posttransplantation month, and urinary excretions of PIIINP, TGF-β1, a1M, albumin and serum C-reactive protein in 79 graft patients at six months after transplantation.The histological findings in six month protocol biopsies were recorded.The patients were followed up to 8.2 (mean 5.9) years.During the first posttransplantation month 30 patients had AR, whereas 106 patients did not show any signs of rejection.In patients with AR, urinary α1M/creatinine and IL-1β/ IL-1ra ratios increased a few days before rejection, whereas in patients with stable graft function urinary α1M/creatinine ratio decreased and IL-1β/IL-1ra ratio remained unchanged.During the follow-up period, GFR deteriorated in 21 patients (progressors), and improved or remained the same in 58 patients.At six month from transplantation, the mean protein/creatinine ratios of PIIINP (220 vs. 102 ng/mmol), TGF-β1 (107 vs. 45 ng/ mmol), albumin (60 vs. 5.4 mg/mmol) and serum concentration of CRP (5.3 vs. 1.4 mg/l) were significantly higher in progressors than in those who preserved good graft function.Urinary excretion of PIIINP associated with the extent of interstitial fibrosis and the excretions of TGF-β1 and α1M.During follow-up, GFR deteriorated in 60% of patients with high α1M/creatinine ratio (> 5 mg/mmol), but only in 2% of patients with low ratio (p< 0.01).The intraindividual baseline concentration of CRP remained constant for the whole follow-up period and correlated inversely with the annual change of GFR (r=-0.688,p<0.01).In conclusion, high production of IL-1ra has a protective role after kidney transplantation and regular measurement of urinary α1M and PIIINP provides a noninvasive means to detect disturbances in the graft function and ongoing renal fibrosis.Low or decreasing α1M/creatinine and PIIINP/creatinine ratios in consequtively collected urine samples together with normal serum concentration of CRP (< 1.7 mg/l) indicate good prognosis, whereas increased ratios and elevated CRP predict poor long-term outcome.
Source: Työväentutkimus Vuosikirja
Author: Anna‐Maija Teppo
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Helsingin Yliopisto
OpenAlex ID: W2154949003