title: [alpha 2-macroglobulin in urine. Significance for differential diagnosis of rejection and infections after kidney transplantation].
abstract: The value of measuring the urinary concentration of alpha 2-macroglobulin in addition to that of C-reactive protein (CRP) was assessed in a prospective study of 78 consecutive patients (29 women, 49 men; mean age 48.7 [19-75] years) after renal transplantation. alpha 2-Macroglobulin was never demonstrated in urine when the course was normal (n = 38), cytomegalovirus infection had occurred (n = 26) or acute cyclosporin nephrotoxicity (n = 5) or glomerular disease in the transplant (n = 10). CRP was present in only a few such cases. Interstitial rejections (n = 26) always led to urinary alpha 2-macroglobulin and CRP excretion without haematuria, while in vascular rejection (n = 3) the haemoglobin test was also positive. Urinary infection (n = 20) and urosepticaemia (n = 6) always brought about the urinary excretion of alpha 2-macroglobulin and CRP, as well as a usually highly positive haemoglobin test. alpha 2-Macroglobulin was absent but CRP always present in extrarenal bacterial infections (n = 30). Postrenal blood admixture was always characterized by a positive haemoglobin test and alpha 2-macroglobulin in urine, while in most cases (83%) CRP was absent. --These results indicate that the constellation "alpha 2-macroglobulin negative/CRP positive" is a pathognomonic for extrarenal bacterial infection (sensitivity 100%, specificity 98.9%). The presence of alpha 2-macroglobulin alone makes postrenal blood admixture probable. If both proteins are present in the urine, rejection and urogenital bacterial infection must be excluded by further tests.
authors.affiliation: Klinik für Innere Medizin, Medizinischen Universität Lübeck.
authors.forename: J
authors.initials: J
authors.lastname: Steinhoff
authors.forename: P
authors.initials: P
authors.lastname: Faerber
authors.forename: R
authors.initials: R
authors.lastname: Preuss
authors.forename: W G
authors.initials: WG
authors.lastname: Wood
authors.forename: K
authors.initials: K
authors.lastname: Sack
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis*; D002097:C-Reactive Protein / Q000652:urine; D016572:Cyclosporine / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006417:Hematuria / Q000175:diagnosis; D006456:Hemoglobinuria / Q000175:diagnosis; D006801:Humans; D007668:Kidney / Q000187:drug effects; D007674:Kidney Diseases / Q000175:diagnosis; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis*; D000511:alpha-Macroglobulins / Q000652:urine*
chemical_list: D000511:alpha-Macroglobulins; D016572:Cyclosporine; D002097:C-Reactive Protein