title: Urine free light chains as a novel biomarker of acute kidney allograft injury.
abstract: BACKGROUND
  We evaluated urine free light chains (FLC) as a potential biomarker for acute kidney allograft injury (AKAI).
  
  
  METHODS
  Urine κ and λ FLC were compared with urine β-2 microglobulin (β2-M), retinol-binding protein (RBP), kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), and microalbuminuria (MAB) in biopsy-confirmed acute rejection (AR) and acute tubular necrosis (ATN). Healthy volunteers (normal) and transplant recipients with normal allograft function (control) were used as references.
  
  
  RESULTS
  Compared with control or normal group (N = 15), urine FLC, MAB, and RBP were higher in ATN (N = 29) and AR (N = 41) groups (p < 0.05). There was no difference in KIM-1, NGAL, or β2-M between four groups. In the AR group, urine κFLC demonstrated the highest predictive value with sensitivity of 95.12% and specificity of 87.5% (p < 0.0001). Urine κFLC also performed best with a sensitivity of 96.55% and specificity of 93.33% (p < 0.0001) in the ATN group. The area under the receiver operating characteristic (ROC) curves (AUC) by ROC analysis is greatest in urine RBP (100%) and FLC (99%), and lowest in KIM-1 (53.5%), then NGAL (71.5%) in the AR group. The AUC is also greatest in urine FLC (100%) and RBP (99%), and lowest in urine KIM-1 (55.6%) and NGAL (69.9%) in the ATN group.
  
  
  CONCLUSIONS
  Urine FLC appears sensitive for both AR and ATN, and it may be a novel AKAI biomarker.
authors.affiliation: Section of Nephrology, Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
authors.forename: Rubin
authors.initials: R
authors.lastname: Zhang
authors.forename: Min
authors.initials: M
authors.lastname: Li
authors.forename: Kanwaljit K
authors.initials: KK
authors.lastname: Chouhan
authors.forename: Eric E
authors.initials: EE
authors.lastname: Simon
authors.forename: Lotuce Lee
authors.initials: LL
authors.lastname: Hamm
authors.forename: Vecihil
authors.initials: V
authors.lastname: Batuman
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000652:urine; D000328:Adult; D015415:Biomarkers / Q000652:urine*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis* / Q000652:urine; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000652:urine*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve
chemical_list: D015415:Biomarkers; D007147:Immunoglobulin Light Chains
keywords: acute kidney injury; acute rejection; acute tubular necrosis; biomarker; kidney transplant; urine free light chains