title: Urine macrophage migration inhibitory factor concentrations as a diagnostic tool in human renal allograft rejection.
abstract: BACKGROUND
  Macrophage migration inhibitory factor (MIF) is a pro-inflammatory cytokine that is a potent activator of macrophages and T cells. Previous studies have shown that local MIF production is increased in acute renal allograft rejection, suggesting that it may play an important role in the rejection process.
  
  
  OBJECTIVE
  To determine if urine and serum MIF concentrations: (1) are increased in acute rejection, and (2) can be used as noninvasive tools to discriminate between acute rejection (AR) and cyclosporine nephrotoxicity (CyA toxicity).
  
  
  METHODS
  In a prospective study of nine renal allograft patients (five acute rejection and four stable), serial urine MIF concentrations were measured by ELISA in the first 14 days after transplantation. In a retrospective study, MIF concentrations in urine and serum were measured in 24 patients who were biopsied for acute renal transplant dysfunction (11 AR, 13 CyA toxicity). Urine and serum MIF were also measured in 23 stable renal transplant patients and 10 normals.
  
  
  RESULTS
  MIF was readily detected in the urine of normal healthy controls (106+/-61 pg/micromol creatinine). In the prospective study, the urinary MIF concentration was increased substantially on day 1 posttransplantation and subsequently fell in parallel with the serum creatinine. However, urine MIF increased before episodes of biopsy proven acute rejection. The retrospective study showed that urine MIF concentrations in patients with AR were increased 5-fold compared to normal controls (439+/-313 pg/micromol Cr; P<0.01). In contrast, urine MIF concentrations in CyA toxicity were not significantly different to normal controls (145+/-119 pg/micromol Cr; P=NS). A marked increase in MIF immunostaining was seen in biopsies of AR, but not in CyA toxicity. No significant differences were evident in serum MIF levels between normals and any transplant patient group.
  
  
  CONCLUSIONS
  These results suggest that measurement of urine MIF concentration may be useful in monitoring renal transplant patients for acute rejection and as a discriminator from cyclosporine nephrotoxicity.
authors.affiliation: Department of Nephrology, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria 3168, Australia.
authors.forename: F G
authors.initials: FG
authors.lastname: Brown
authors.forename: D J
authors.initials: DJ
authors.lastname: Nikolic-Paterson
authors.forename: S J
authors.initials: SJ
authors.lastname: Chadban
authors.forename: J
authors.initials: J
authors.lastname: Dowling
authors.forename: M
authors.initials: M
authors.lastname: Jose
authors.forename: C N
authors.initials: CN
authors.lastname: Metz
authors.forename: R
authors.initials: R
authors.lastname: Bucala
authors.forename: R C
authors.initials: RC
authors.lastname: Atkins
mesh_terms: D000328:Adult; D016572:Cyclosporine / Q000506:poisoning; D003937:Diagnosis, Differential; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis* / Q000652:urine*; D006801:Humans; D007166:Immunosuppressive Agents / Q000506:poisoning; D007668:Kidney / Q000378:metabolism / Q000473:pathology; D007674:Kidney Diseases / Q000139:chemically induced / Q000175:diagnosis; D016030:Kidney Transplantation; D008263:Macrophage Migration-Inhibitory Factors / Q000097:blood / Q000378:metabolism / Q000652:urine*; D008297:Male; D008875:Middle Aged; D009994:Osmolar Concentration; D011446:Prospective Studies; D012189:Retrospective Studies; D014184:Transplantation, Homologous
chemical_list: D007166:Immunosuppressive Agents; D008263:Macrophage Migration-Inhibitory Factors; D016572:Cyclosporine