Urinary and aminopeptidase N in the diagnosis of graft rejection after live donor renal transplantation

Krishna, K. Sri; Kirubakaran, M.G.; Pandey, Abhishek; Kanagasabapathy, A. S.

doi:10.1016/0009-8981(85)90257-8

Cited by 18 publications

(10 citation statements)

References 10 publications

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“…In addition, they evaluated the proximal tubular antigen adenosine deaminase binding protein (ABP) which was useful for detecting renal transplant rejection (Mueller et al 1990;Tolkoff-Rubin et al 1986). AAP and GGT were more sensitive and specific than NAG, which agrees with the results of studies of patients treated with conventional immunosuppressants (Corbett et al 1983;Horpacsy 1983;Jung et al 1986;Krishna et al 1985). The patients were studied from 1 to a maximum of 28 days post-transplant.…”

Section: Urinary Enzyme Excretionsupporting

confidence: 80%

“…Considerable controversy exists regarding the use of urinary enzyme excretion as indicators of transplant rejection (Corbett et al 1983;Horpacsy 1983;Jung et al 1986;Kotanko et al 1986;Krishna et al 1985;Mueller et al 1990). Recently Mueller et al (1990) examined the predictive values of enzyme excretion in rejection as compared with plasma creatinine in 104 renal transplant recipients.…”

Section: Urinary Enzyme Excretionmentioning

confidence: 99%

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Pharmacodynamic Monitoring of Cyclosporin

Awni

1992

Clinical Pharmacokinetics

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The efficacy of cyclosporin as an immunosuppressive agent is largely based on clinical indicators such as graft survival, rejection or nephrotoxicity. Therapeutic monitoring is necessary to evaluate the efficacy of cyclosporin therapy. The most widely used method for monitoring cyclosporin therapy is the measurement of predose through blood concentrations of the drug. The relationship of a single or multiple blood cyclosporin concentration to slowly evolving outcomes is difficult to establish. Some investigators have found a good correlation between cyclosporin trough concentrations on the one hand and cyclosporin toxicity and rejection on the other, but others have not. Therapeutic monitoring of cyclosporin may be enhanced using some biological assays for immunosuppression (pharmacodynamic monitoring) in addition to cyclosporin trough concentrations (pharmacokinetic monitoring). However, direct monitoring of the immune response to cyclosporin therapy using a clinically applicable biological assay is difficult. Some pharmacodynamic parameters have been suggested as biological markers in the clinical monitoring of cyclosporin.

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Section: Urinary Enzyme Excretionsupporting

confidence: 80%

Section: Urinary Enzyme Excretionmentioning

confidence: 99%

Pharmacodynamic Monitoring of Cyclosporin

Awni

1992

Clinical Pharmacokinetics

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“…Urinary NAG has repeatedly been shown to be a sensitive but unspecific marker of renal tubular damage in a range of experimental and clinical conditions, such as nephrotoxicity [20, 21], graft rejection [22, 23, 24], and systemic hypotension [25]. In the present study, urinary NAG has been shown to be significantly increased in INF grafts, irrespective of the underlying cause.…”

Section: Discussionsupporting

confidence: 55%

Urinary N-Acetyl-β-<i>D</i>-Glucosaminidase and Neopterin Aid in the Diagnosis of Rejection and Acute Tubular Necrosis in Initially Nonfunctioning Kidney Grafts

Kotanko

Margreiter

Pfaller

2000

Nephron

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Aim: The study aimed at investigating urinary neopterin, a marker of cellular immune response, and urinary N-acetyl-β-D-glucosaminidase (NAG), a marker of tubular damage, as noninvasive means to differentiate between acute tubular necrosis (ATN) and rejection in initially nonfunctioning (INF) human renal transplants. Methods: Seventy-two renal transplant patients were studied. Forty-five of them experienced an uncomplicated early posttransplant course, 27 patients suffered from INF. Twenty-two patients experienced ATN, 5 patients had a total of six biopsy-proven rejections. The NAG activity was measured by a colorimetric assay, neopterin by high-performance liquid chromatography. Receiver operating characteristics (ROC) analysis was applied to compute diagnostic performance and an optimal discriminating threshold. Results: Demographic characteristics (age, gender, cold and warm ischemia periods, HLA mismatches) and posttransplant urinary NAG and neopterin excretions did not differ between ATN and rejection groups. Both urinary NAG and neopterin excretions were lower in the control group (NAG 1.8 ± 1.0 U/mmol urinary creatinine; neopterin 270 ± 126 nmol/mmol urinary creatinine; mean ± SD) as compared with the ATN group (NAG 12 ± 10 U/mmol, p < 0.001 vs. control group; neopterin 303 ± 195 nmol/mmol, n.s.) and the rejection group (NAG 7 ± 8 U/mmol, p < 0.01; neopterin 508 ± 419 nmol/mmol, p < 0.01). The ratio of urinary neopterin to NAG excretion (uNNR; dimension nmol neopterin/U NAG activity) increased during rejections as compared with ATN (139 ± 74 vs. 50 ± 38 nmol/U, p < 0.01). The area under the ROC curve for uNNR was 0.88 ± 0.07 (p < 0.001). Applying a ROC-estimated optimal discriminator of uNNR (80 nmol/U), 16 patients with ATN and all six rejection episodes were classified correctly. Conclusion: The uNNR provides a noninvasive means to aid in the differential diagnosis of rejection and ATN in INF human renal transplants.

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“…Urinary NAG activity is an extremely sensitive index of renal parenchymal damage [9. 10], a reliable test to use in monitoring the progression of kidney diseases [11], and an early indicator of immune rejection in patients with renal allografts [3][4][5]. AAP are a group of hydrolases (molecular weight 240.000) located in the brush border membrane of the proximal tubule [12]; however, urinary AAP activity has seldom been reported as a marker in renal pathology [5.…”

Section: Introductionmentioning

confidence: 99%

“…a renal tu bule lysosomal enzyme, and alanine aminopeptidase (AAP; EC 3.4.11.2). a kidney brush border hydrolase, are the most widely used [5][6][7][8]. Urinary NAG activity is an extremely sensitive index of renal parenchymal damage [9.…”

Section: Introductionmentioning

confidence: 99%

Cyclosporine Nephrotoxicity and Rejection Crisis: Diagnosis by Urinary Enzyme Excretion

Börnstein¹,

Arenas²,

Morales³

et al. 1996

Nephron

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The urinary enzymes alanine aminopeptidase (AAP; EC 3.4.11.2) and N-acetyl-B-D-glucosaminidase (NAG; EC 3.2.1.30) were measured daily in 35 renal transplant recipients during the early postoperative period. Each peak value of fractional excretion was corrected for its baseline value (CFE). CFE values above normal for both NAG and AAP were more frequently found in episodes of acute rejection than in cyclosporine acute nephrotoxicity episodes (76 vs. 0%; p < 0.001). Consequently, a rise in CFE levels for both NAG and AAP is strongly suggestive of acute rejection crisis.

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Urinary and aminopeptidase N in the diagnosis of graft rejection after live donor renal transplantation

Cited by 18 publications

References 10 publications

Pharmacodynamic Monitoring of Cyclosporin

Pharmacodynamic Monitoring of Cyclosporin

Urinary N-Acetyl-β-<i>D</i>-Glucosaminidase and Neopterin Aid in the Diagnosis of Rejection and Acute Tubular Necrosis in Initially Nonfunctioning Kidney Grafts

Cyclosporine Nephrotoxicity and Rejection Crisis: Diagnosis by Urinary Enzyme Excretion

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