Urinary NGAL Ratio Is Not a Sensitive Biomarker for Monitoring Acute Tubular Injury in Kidney Transplant Patients: NGAL and ATI in Renal Transplant Patients

Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is known to predict the prolonged delayed graft function after kidney transplantation. We examined the relation of uNGAL with histological findings of acute tubular injury (ATI). Analyses were made in biopsies taken at 6 weeks, 3 months, and 6 months after kidney transplantation. uNGAL was measured in the spot urines, normalized to urinary creatinine excretion, and correlated to biopsy findings and clinical, laboratory, and demographic variables. Controls included healthy individuals, individuals after kidney donation and ICU patients with acute kidney failure. Renal transplant recipients without ATI did not display elevated uNGAL levels compared to the healthy controls. Transplant patients with ATI had a higher uNGAL excretion at 6 weeks than patients without ATI (27,435 versus 13,605 ng/g;P=0.031). This increase in uNGAL was minor compared to ICU patients with acute renal failure (2.05×106 ng/g). Patients with repeated findings of ATI or severe ATI did not have higher urinary NGAL levels compared to those with only one ATI finding or moderate ATI. Female recipient gender and urinary tract infection were identified as potential confounders. uNGAL has a relation with histological signs of acute tubular injury. The usability of this biomarker in renal allograft recipients is limited because of the low sensitivity.

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Evaluation the performance of serum neutrophil gelatinase associated lipocalin as a biomarker of allograft dysfunction in kidney recipients from living donors

Journal of Renal Injury Prevention ◽

10.34172/jrip.2021.30 ◽

2021 ◽

Vol 10 (4) ◽

pp. e30-e30

Author(s):

Elham Adlravan ◽

Farid Javandoust Gharehbagh ◽

Ali Taghizadeh Afshari ◽

Behzad Baradaran ◽

Jaffar Nourooz-Zadeh

Keyword(s):

Renal Transplant ◽

Graft Function ◽

Living Donors ◽

Post Transplantation ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Allograft Dysfunction ◽

Transplant Patients ◽

Kidney Recipients ◽

Renal Transplant Patients ◽

Neutrophil Gelatinase

Introduction: Serum neutrophil gelatinase-associated lipocalin (sNGAL) has been proposed as an early biomarker for the prediction of delayed graft function (DGF) from cadaveric donors. Objectives: The purposes of this investigation were to explore the time-based trend for sNGAL in kidney recipients from living donors and to evaluate its correlation with graft function recovery during a one-year follow-up. Patients and Methods: Kidney recipients (n=39) were consecutively enrolled. Sample collection was performed before transplantation and at 2, 16, 24, 36, 48 hours after surgery. Kidney recipients were split into immediate graft function (IGF) and DGF based on estimated glomerular filtration rate (eGFR) on day 5 post-surgery. eGFRs >60 mL/min/1.73 m2 on day 5 post-transplantation were considered as IGF. sNGAL was assessed by ELISA. Serum creatinine (sCr) was measured by the Jaffe method. Results: Rates of participants with IGF or DGF were 25 and 14, respectively. Pre-surgery, sNGAL levels in the DGF subset were 21% higher than that of the IGF group. At 2-hours checkpoint, area under curve, sensitivity, specificity and cut-off (ng/mL) for sNGAL were 0.73, 100%, 52% and 151.8. sNGAL levels correlated with allograft function at 6, 9 and 12 months post-transplantation (r=0.66; P=0.007; r=0.836; P=0.031 and r=0.93; P=0.016). Conclusion: We have uncovered that monitoring sNGAL in kidney recipients is a useful biomarker for the evaluation of short- and long postoperative outcome in renal transplant patients from living donors. However, multicenter study with large samples-size is required to ascertain the usefulness of sNGAL as diagnostic tool for the evaluation of allograft dysfunction in renal transplant patients from living donors.

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Prevalence of Hypercalcaemia in a Renal Transplant Population: A Single Centre Study

International Journal of Nephrology ◽

10.1155/2016/7126290 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Tony Amin ◽

P. Toby Coates ◽

Jeffrey Barbara ◽

Paul Hakendorf ◽

Nazmul Karim

Keyword(s):

Renal Transplant ◽

Elevated Serum ◽

Graft Function ◽

South Australia ◽

Chronic Glomerulonephritis ◽

High Dose ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Transplant Patients

Introduction. Postrenal transplant bone disease is a significant problem. Factors influencing postrenal transplant bone status include high dose acute and low dose long-term steroid use, persistent hypercalcaemia, and graft failure. In this study, we aimed to determine the prevalence of hypercalcaemia and to evaluate the risk factors for postrenal transplant hypercalcaemia in long-term renal transplant patients at our centre.Methods. This is a biochemical audit in which we studied renal transplant recipients from the Central Northern Adelaide Renal Transplant Services, South Australia. Inclusion criteria include kidney transplant patients with functioning graft since 1971 and at least 3 months after transplantation at the time of analysis. Hypercalcaemia was defined as persistently elevated serum corrected calcium greater than or equal to 2.56 mmol/L for three consecutive months.Results. 679 renal transplant recipients with a functioning graft were studied and 101 were hypercalcaemic between March 2011 and June 2011 (15%). 60% of the hypercalcaemic patients were male and 40% were female, with chronic glomerulonephritis (39%) being the commonest cause of their end stage kidney disease (ESKD). Prevalence was similar in those that had haemodialysis and peritoneal dialysis pretransplantation. Hypercalcaemia in the renal transplant population was not secondary to suboptimal allograft function but secondary to pretransplantation hyperparathyroidism with persistent high parathyroid hormone (PTH) levels after transplantation.Conclusion. There is a high prevalence of hypercalcaemia (15%) in renal transplant recipients. The predominant cause for hypercalcaemia is pretransplantation hyperparathyroidism. The magnitude of pretransplantation hyperparathyroidism is the major determinant for long-term parathyroid function rather than graft function or pretransplantation duration on dialysis or mode of dialysis.

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The role of radioisotope renography (MAG3) in renal transplant patients with delayed graft function

10.26226/morressier.58736691d462b802923841c1 ◽

2017 ◽

Author(s):

Ashar Wadoodi

Keyword(s):

Renal Transplant ◽

Graft Function ◽

Delayed Graft Function ◽

Radioisotope Renography ◽

Transplant Patients ◽

Renal Transplant Patients

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Higher CD19+CD25+ Bregs are independently associated with better graft function in renal transplant recipients

BMC Nephrology ◽

10.1186/s12882-021-02374-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Eman H. Ibrahim ◽

Mostafa G. Aly ◽

Gerhard Opelz ◽

Christian Morath ◽

Martin Zeier ◽

...

Keyword(s):

Renal Transplant ◽

B Cell ◽

Graft Function ◽

Cell Subset ◽

Immunosuppressive Drugs ◽

Renal Transplant Recipients ◽

Healthy Controls ◽

Transplant Recipients ◽

Significant Positive Association ◽

Ifn Γ

Abstract Background The Identification of B cell subsets with regulatory functions might open the way to new therapeutic strategies in the field of transplantation, which aim to reduce the dose of immunosuppressive drugs and prolong the graft survival. CD25 was proposed as a marker of a B-cell subset with an immunosuppressive action termed Bregs. The effect of CD19 + CD25 + Bregs on graft function in renal transplant recipients has not yet been elucidated. We investigated a potential impact of CD19 + CD25 + Bregs on renal graft function as well as a possible interaction of CD19 + CD25 + Bregs with peripheral Tregs in healthy controls, end-stage kidney disease patients (ESKD), and renal transplant recipients. Moreover, we aimed to investigate the association of CD19 + CD25 + Bregs with serum IL-10, TGF-ß1, and IFN-γ in the same study groups. Method Thirty-one healthy controls, ninety renal transplant recipients, and eighteen ESKD patients were enrolled. We evaluated the CD19 + CD25 + Bregs and Treg absolute counts. Next, we investigated CD19 + CD25 + Bregs as predictors of good graft function in multiple regression and ROC analyses. Finally, we evaluated the association between CD19 + CD25+ Bregs and serum IL-10, TGF-ß, and IFN-γ. Results ESKD patients and renal transplant recipients showed lower counts of CD19 + CD25+ Bregs compared to healthy controls (p < 0.001). Higher CD19 + CD25+ Breg counts were independently associated with a better GFR in renal transplant recipients (unstandardized B coefficient = 9, p = 0.02). In these patients, higher CD19 + CD25+ Bregs were independently associated with higher Treg counts (unstandardized B = 2.8, p = 0.004). In ROC analysis, cut-offs for CD19 + CD25 + Breg counts and serum TGF-ß1 of 0.12 cell/μl and 19,635.4 pg/ml, respectively, were shown to provide a good sensitivity and specificity in identifying GFR ≥ 30 ml/min (AUC = 0.67, sensitivity 77%, specificity 43%; AUC = 0.65, sensitivity 81%, specificity 50%, respectively). Finally, a significant positive association between CD19 + CD25+ Bregs and TGF-ß1 was shown in renal transplant recipients (r = 0.255, p = 0.015). Conclusions Our findings indicate that higher counts of CD19 + CD25+ Bregs are independently associated with better renal function and higher absolute Treg counts in renal transplant recipients.

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Tacrolimus-Based Immunosuppressive Therapy Influences Sex Hormone Profile in Renal-Transplant Recipients—A Research Study

Biology ◽

10.3390/biology10080709 ◽

2021 ◽

Vol 10 (8) ◽

pp. 709

Author(s):

Dagmara Szypulska-Koziarska ◽

Aleksandra Wilk ◽

Małgorzata Marchelek-Myśliwiec ◽

Daria Śleboda-Taront ◽

Barbara Wiszniewska

Keyword(s):

Renal Transplant ◽

Immunosuppressive Therapy ◽

Follicle Stimulating Hormone ◽

Plasma Concentrations ◽

Graft Function ◽

Hormonal Status ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Study Results ◽

Stimulating Hormone

It is estimated that approximately 20% of couples suffer from infertility worldwide and within renal-transplant recipients, this problem is 10 times more common. An intake of immunosuppressants may lead to hormonal imbalance. The aim of the study was to investigate the influence of tacrolimus-based therapy on the hormonal status of grafted patients. Blood samples were obtained from patients from the Department of Nephrology, Transplantology, and Internal Medicine of Independent Public Clinical Hospital No. 2, Pomeranian Medical University. All 121 patients had stable graft function for over 6 months. The blood plasma concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, estradiol, cortisol were assessed by the electrochemiluminescence method. We observed decreased levels of prolactin (11.9 ng/mL) and cortisol (87.4 μg/mL) in patients under tacrolimus-based therapy. Tacrolimus-based therapy was also associated with increased testosterone and follicle-stimulating hormone in males, 4.04 ng/mL and 6.9 mLU/mL, respectively, and decreased testosterone levels in females, 0.121 ng/mL. We also assessed that immunosuppressive therapy based on tacrolimus is less nephrotoxic in comparison to other regimens. Concluding, tacrolimus-based therapy may influence the hormonal status of transplant recipients in the current study. Results presented here are believed to be helpful for clinicians and patients, especially within the aspect of willingness for biological offspring.

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Calcium and phosphate levels after kidney transplantation and long-term patient and allograft survival

Clinical Kidney Journal ◽

10.1093/ckj/sfaa061 ◽

2020 ◽

Author(s):

Julio Chevarria ◽

Donal J Sexton ◽

Susan L Murray ◽

Chaudhry E Adeel ◽

Patrick O’Kelly ◽

...

Keyword(s):

Risk Factors ◽

Renal Transplant ◽

Graft Failure ◽

Graft Function ◽

Renal Transplant Recipients ◽

Post Transplant ◽

All Cause Mortality ◽

Transplant Function ◽

The Republic ◽

The Impact

Abstract Background Non-traditional cardiovascular risk factors, including calcium and phosphate derangement, may play a role in mortality in renal transplant. The data regarding this effect are conflicting. Our aim was to assess the impact of calcium and phosphate derangements in the first 90 days post-transplant on allograft and recipient outcomes. Methods We performed a retrospective cohort review of all-adult, first renal transplants in the Republic of Ireland between 1999 and 2015. We divided patients into tertiles based on serum phosphate and calcium levels post-transplant. We assessed their effect on death-censored graft survival and all-cause mortality. We used Stata for statistical analysis and did survival analysis and spline curves to assess the association. Results We included 1525 renal transplant recipients. Of the total, 86.3% had hypophosphataemia and 36.1% hypercalcaemia. Patients in the lowest phosphate tertile were younger, more likely female, had lower weight, more time on dialysis, received a kidney from a younger donor, had less delayed graft function and better transplant function compared with other tertiles. Patients in the highest calcium tertile were younger, more likely male, had higher body mass index, more time on dialysis and better transplant function. Adjusting for differences between groups, we were unable to show any difference in death-censored graft failure [phosphate = 1.14, 95% confidence interval (CI) 0.92–1.41; calcium = 0.98, 95% CI 0.80–1.20] or all-cause mortality (phosphate = 1.10, 95% CI 0.91–1.32; calcium = 0.96, 95% CI 0.81–1.13) based on tertiles of calcium or phosphate in the initial 90 days. Conclusions Hypophosphataemia and hypercalcaemia are common occurrences post-kidney transplant. We have identified different risk factors for these metabolic derangements. The calcium and phosphate levels exhibit no independent association with death-censored graft failure and mortality.

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