Do serum C-reactive protein measurements help to discriminate episodes of renal dysfunction in patients after renal transplantation?
BACKGROUND
This study investigated whether serial daily measurements of serum C-reactive protein (sCRP) could help differentiate episodes of transplant dysfunction due to rejection, infection, cyclosporine A (CsA) nephrotoxicity, or acute tubular necrosis (ATN) in renal-allograft recipients.


METHODS
Morning serum was obtained daily from 134 patients during the first 30 days after renal transplantation. All episodes of graft dysfunction were recorded and differentiated with transplant biopsies. CRP concentrations were correlated with post-operative graft function and the various causes of graft dysfunction.


RESULTS
All patients showed an increase in sCRP in response to surgery, with a maximum on day 2 after transplantation. The sCRP concentration was significantly higher in patients with delayed graft function (mean 61.50 microg/ml) than in patients with primary graft function (mean 38.01 microg/ml) (p=0.001). Bacterial infections other than asymptomatic bacteriuria (mean sCRP 33.98 microg/ml), interstitial graft rejection (mean sCRP 16.43 microg/ml), and ATN (mean sCRP 30.50 microg/ml) were accompanied by significant increases in sCRP compared with uneventful courses. sCRP was unchanged in the presence of viral infections or CsA toxicity.


CONCLUSIONS
Serial sCRP measurements help to identify renal-transplant dysfunction of different origins. However, rejection, infection and ATN show similar patterns of sCRP increase. Thus, sCRP is unable to discriminate the causes of renal-graft dysfunction. Biopsy remains the gold standard for the differential diagnosis of renal-allograft dysfunction.
Reek
C
C
Urologische Klinik und Poliklinik, Medizinische Fakultät der Universität Rostock, Ernst-Heydemann-Str. 6, Postfach 10 08 88, D 18055, Rostock, Germany. christian.reek@gmx.de
Conrad
S
S
Tenschert
W
W
Huland
H
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003586:Cytomegalovirus Infections / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000097:blood; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged
D002097:C-Reactive Protein