title: Urine of patients with acute kidney transplant rejection show high normetanephrine and decreased 2-hydroxyestrogens concentrations.
abstract: BACKGROUND
  A shift from anti- to proinflammatory steroid hormones has been observed in chronic inflammation. We tested the hypothesis that this shift occurs also in kidney transplant rejection together with a rise of urinary catecholamine degradation product concentrations as a consequence of locally produced cytokines, thus further promoting rejection.
  
  
  METHODS
  We examined 8 patients with an early rejection episode in the protocol biopsy ∼2 weeks, 9 with biopsy-proven rejection at 2-3 months, and 18 without rejection, both at 2 weeks and 3 months after transplantation. Metanephrine, normetanephrine, and 2- and 16-hydroxyestrogens concentrations were measured by EIA.
  
  
  RESULTS
  The median urinary concentrations of normetanephrine, but not metanephrine, were significantly higher in acute kidney transplant rejection in the first 2 weeks after transplantation (P < .05). During acute kidney transplant rejection at 2-3 months, but not in the first 2 weeks, after transplantation, 2-, but not 16-hydroxyestrogens, concentrations were significantly decreased (P < .05).
  
  
  CONCLUSIONS
  We demonstrated that the downstream product of noradrenaline conversion normetanephrine was elevated in kidney transplant rejection in the first weeks after transplantation. This change may promote rejection together with an important proinflammatory and mitogenic steroid hormone shift, which becomes increasingly relevant over time.
authors.affiliation: Klinik und Poliklinik für Innere Medizin II, Department of Internal Medicine I, University of Regensburg, Regensburg, Germany. stephan.reinhold@klinik.uni-regensburg.de
authors.forename: S W
authors.initials: SW
authors.lastname: Reinhold
authors.forename: R H
authors.initials: RH
authors.lastname: Straub
authors.forename: T
authors.initials: T
authors.lastname: Bergler
authors.forename: U
authors.initials: U
authors.lastname: Hoffmann
authors.forename: B
authors.initials: B
authors.lastname: Krüger
authors.forename: M C
authors.initials: MC
authors.lastname: Banas
authors.forename: M C
authors.initials: MC
authors.lastname: Kammerl
authors.forename: D
authors.initials: D
authors.lastname: Kollins
authors.forename: B K
authors.initials: BK
authors.lastname: Krämer
authors.forename: B
authors.initials: B
authors.lastname: Banas
mesh_terms: D000328:Adult; D004967:Estrogens / Q000652:urine*; D005260:Female; D006084:Graft Rejection / Q000652:urine*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009647:Normetanephrine / Q000652:urine*
chemical_list: D004967:Estrogens; D009647:Normetanephrine