Diagnosing Acute Kidney Rejection through Urinary Proteome Analysis

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This article is part of our ongoing coverage of Renal Week 2009. Click here for a complete list of our Renal Week Live articles.


Key Points

  • It may be possible to detect acute allograft rejection in kidney transplant patients by urinary proteome analysis.
  • Currently, an allograft biopsy is required to diagnose acute rejection after renal transplantation.
  • Electrophoresis-mass spectrometry correctly classified 14 of 15 subclinical, 11 of 11 clinical, and 28 of 39 non-rejection samples in the validation set.

It may be possible to detect acute allograft rejection in kidney transplant patients by urinary proteome analysis, according to a new German study that was presented at ASN's Renal Week 2009.

Currently, an allograft biopsy is required to diagnose acute rejection after renal transplantation. It is usually performed if there appears to be functional graft impairment or as part of a surveillance protocol. While protocol biopsies can detect rejection at the subclinical stage and allow for prompt initiation of treatment, they are invasive and carry risks.

Researchers in Hannover, Germany, investigated the use of capillary electrophoresis-mass spectrometry (CE-MS) to measure changes in the low molecular weight urinary proteome in a single voided urinary samples from renal transplant recipients with acute T-cell mediated tubulointerstitial rejection.

For this investigation, differential peptides were defined by statistical comparison of CE-MS spectra of 20 patients with and 26 patients without biopsy-proven subclinical rejection according to Banff 1997 criteria.

The researchers then established a multi-marker classification model and validated the technique in an independent set of 82 renal transplant recipients. CE-MS correctly classified 14 of 15 subclinical, 11 of 11 clinical, and 28 of 39 non-rejection samples in the validation set.

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