SEQUENTIAL MONITORING OF URINE-SOLUBLE INTERLEUKIN 2 RECEPTOR AND INTERLEUKIN 6 PREDICTS ACUTE REJECTION OF HUMAN RENAL ALLOGRAFTS BEFORE CLINICAL OR LABORATORY SIGNS OF RENAL DYSFUNCTION
作者:
Casiraghi1 Federica,
Ruggenenti1,2 Piero,
Noris1,3 Marina,
Locatelli4 Giuseppe,
Perico1,2 Norberto,
Perna1 Annalisa,
Remuzzi1,2 Giuseppe,
期刊:
Transplantation
(OVID Available online 1997)
卷期:
Volume 63,
issue 10
页码: 1508-1514
ISSN:0041-1337
年代: 1997
出版商: OVID
数据来源: OVID
摘要:
Background.The significance of noninvasive techniques to the early diagnosis of acute rejection in kidney transplants remains elusive. In this study, we examined whether an early posttransplant increase in serum- and urine-soluble interleukin (IL) 2 receptor (sIL-2R) and IL-6 levels predicted acute rejection.Methods.Sequential determinations of serum and urine sIL-2R and IL-6 were performed in the first 30 postoperative days in 40 renal transplant patients. Changes during the posttransplant period observed in 26 patients who had one or more episodes of acute rejection (group A) were compared with those recorded in 14 patients who did not experience acute rejection of their graft (group B).Results.Serum sIL-2R was higher than normal in patients of groups A and B without statistical differences between the two groups. In the first 3 days after transplantation, urinary sIL-2R was higher than normal in group A but not in group B. Urinary sIL-2R at days 2 and 3 was significantly higher (P<0.05) in group A than in group B. In the first 5 days after transplantation, urinary IL-6 was persistently higher than normal in group A, whereas it progressively decreased to normal value on day 4 in group B. Sudden increases (doubling within 24 hr) in urine IL-6 preceded clinical diagnosis of acute rejection by a mean period of 2 days, with an 87% sensitivity and a 64% specificity, and also predicted recurrent rejection episodes.Conclusions.Sequential monitoring of urinary sIL-2R and IL-6 levels does allow very early diagnosis of rejection without invasive procedures. Specifically, high urinary sIL-2R in the first 5 posttransplant days identifies the subgroup of patients at risk. In the subsequent days, a sudden increase in urinary IL-6 occurs in those of the above patients who will indeed reject their graft.
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