Nephrol Dial Transplant Vol. 19 No. 11 © ERA-EDTA 2004; all rights reserved
Original Article
Time course of low molecular weight proteins in the early kidney transplantation period—influence of corticosteroids
1 Department of Internal Medicine I, University of Bonn, Germany, 2 Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands and 3 Department of Clinical Biochemistry, University of Bonn, Germany
Correspondence and offprint requests to: Dr Uwe Pöge, Medizinische Klinik u. Poliklinik I, -Allgemeine Innere Medizin, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, D 53105 Bonn, Germany. Email: u.poege{at}uni-bonn.de
Background. Cystatin C (Cys C) is an established new marker of renal function in patients with various renal diseases and in kidney transplantation. However, few data are available for the early post-transplantation period.
Methods. Twenty-two patients who underwent renal transplantation (RTx) were evaluated for the kinetics of Cys C from day 0 to 14 in relation to creatinine and beta-2 microglobulin (B2MG). Blood samples were obtained immediately before and after transplantation and on a daily basis thereafter. Serum levels before transplantation (100%) were used to calculate reduction ratios.
Results. The decrease of the analytes differed considerably: immediately after RTx Cys C declined by 27.3% (P<0.01). However, after 3 days, on average, all patients showed a significant increase in Cys C levels (15±2.5%; P<0.01). B2MG levels fell quickly by 55.4 and 73.8% after days 1 and 7, respectively, and remained stable thereafter. In contrast, creatinine did not decease immediately after RTx but fell slowly by 67.5% at the end of the study. Prior to rejection, all analytes showed a similar behaviour. Rejection treatment with high-dose methylprednisolone induced a significant increase in Cys C (+22.8±7.9%, P<0.05), while in parallel, creatinine and B2MG decreased (–12.9±3.4 and –8.4±6.89%).
Conclusions. Corticosteroid treatment for induction of immunosuppression or rejection therapy significantly induces Cys C, but decreases B2MG. Cys C and B2MG are not helpful in establishing the diagnosis of rejection earlier. Thus, our data indicate that Cys C and B2MG testing does not accurately reflect changes in the glomerular filtration rate early after transplantation.
Keywords: beta-2 microglobulin; creatinine; cystatin C; kidney transplantation
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