title: Acute renal allograft rejection is associated with increased levels of vascular endothelial growth factor in the urine.
abstract: OBJECTIVE
  The purpose of this study was to assess whether measurement of urinary vascular endothelial growth factor (VEGF) could be adopted as a new non-invasive diagnostic tool for acute rejection following renal transplantation.
  
  
  METHODS
  Urinary concentration of VEGF was determined by an enzyme-linked immunosorbent assay technique in 215 renal allograft recipients and 80 healthy controls.
  
  
  RESULTS
  Subjects with acute rejection (n=67) excreted urinary VEGF at a significantly higher level (28.57+/-6.21, 95% CI: 16.18-40.97 pg/mumol creatinine) than those without acute rejection. This included subjects with stable renal function and no abnormal histological findings (n=119), acute tubular necrosis (n=15), chronic allograft nephropathy (n=14) and healthy controls (n=80). Using a urinary VEGF/creatinine ratio of 3.64 pg/micromol as the cut-off point, the sensitivity and specificity for diagnosing acute rejection were 85.1 and 74.8%, respectively (P<0.001). Patients with steroid-resistant acute rejection had significantly greater urinary VEGF concentration than patients with steroid-sensitive acute rejection (42.09+/-10.00 vs 9.74+/-2.63 pg/micromol creatinine, P<0.001). Patients with graft loss after acute rejection had significantly greater urinary VEGF concentration than patients with reversible acute rejection (106.66+/-38.60 vs 19.46+/-4.13 pg/micromol creatinine, P=0.001). Using a urinary VEGF/creatinine ratio of 22.48 pg/micromol as the cut-off point, the sensitivity and specificity of the prediction to graft loss after acute rejection were 85.7% and 78.3%, respectively (P=0.001).
  
  
  CONCLUSIONS
  This study demonstrates that the monitoring of urinary VEGF may be a useful non-invasive approach for the detection of acute rejection. Additionally, urinary VEGF levels were shown to predict the response to anti-rejection therapy and to predict a poor outcome after acute rejection.
authors.affiliation: Center of Kidney Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
authors.forename: Wenhan
authors.initials: W
authors.lastname: Peng
authors.forename: Jianghua
authors.initials: J
authors.lastname: Chen
authors.forename: Yuguang
authors.initials: Y
authors.lastname: Jiang
authors.forename: Zhangfei
authors.initials: Z
authors.lastname: Shou
authors.forename: Ying
authors.initials: Y
authors.lastname: Chen
authors.forename: Huiping
authors.initials: H
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000652:urine; D001706:Biopsy; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000473:pathology / Q000652:urine*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000652:urine*
chemical_list: D015415:Biomarkers; D042461:Vascular Endothelial Growth Factor A