title: Urinary monocyte chemoattractant protein-1 levels and interstitial changes in the renal cortex and their relationship with loss of renal function in renal transplant patients with delayed graft function.
abstract: BACKGROUND
  Inflammatory cell infiltration and residual areas of fibrosis in kidneys after renal transplantation can lead to functional abnormalities with long-term implications.
  
  
  OBJECTIVE
  The aim of this study was to determine urinary monocyte chemoattractant protein-1 (uMCP-1) levels, relative cortical interstitial area (RCIA), and cortical tubulointerstitial macrophage infiltration in renal transplant patients with delayed graft function (DGF) and their possible correlation with graft outcome.
  
  
  METHODS
  Patients were followed after biopsies for one year, and their renal function and structure were evaluated, as well as parameters of inflammatory process.
  
  
  METHODS
  Clinical Hospital of the School of Medicine of Ribeirão Preto.
  
  
  METHODS
  Twenty-two cadaveric kidney transplant recipients with DGF were followed for one year.
  
  
  METHODS
  Renal function, RCIA, macrophages infiltration and uMCP-1 levels were evaluated.
  
  
  METHODS
  Renal function was evaluated by plasma creatinine levels. RCIA was determined by morphometry. Immunohistochemical staining of macrophages was performed using an anti-CD68 monoclonal antibody. uMCP-1 levels were determined using a human MCP-1/CCL2 immunoassay kit.
  
  
  RESULTS
  There was a significant increase in uMCP-1 levels in transplant patients compared with controls (p < 0.001). RCIA was 7.1% (6.4 to 9.2; median and 25th to 75th percentiles) in controls and 37.1% (28.1 to 43.7) in patients with kidney transplants (p < 0.001). The patients who presented with a higher RCIA in the first biopsy showed higher levels of plasma creatinine one year after transplantation (r = 0.44; p < 0.05). The number of tubulointerstitial macrophages per 0.10 mm(2) grid field was higher in the renal cortex of transplant patients compared with the controls (19.4 (9.0 to 47.1) vs. 2.5 (1.8 to 3.4), p < 0.001). There was also a positive correlation between the RCIA and the number of tubulointerstitial macrophages in the renal cortex of these patients (r = 0.49; p < 0.001).
  
  
  CONCLUSIONS
  The number of patients studied was relatively small and may not be reflecting outcomes over a larger spectrum of kidney cadaveric transplants.
  
  
  CONCLUSIONS
  Our results demonstrate increased levels of uMCP-1 in transplant patients with DGF, in addition to increased tubulointerstitial macrophage infiltration and RCIA, which could predict the outcome of renal function in these patients.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Moyses Neto
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP Brazil.
authors.forename: Elen A
authors.initials: EA
authors.lastname: Romão
authors.affiliation: Department of Pathology, Faculty of Medicine of Ribeirão Preto, São Paulo University, Ribeirão Preto, SP Brazil.
authors.forename: Gyl Eb
authors.initials: GE
authors.lastname: Silva
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP Brazil.
authors.forename: Marcio
authors.initials: M
authors.lastname: Dantas
authors.affiliation: Department of Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Avenida Bandeirantes, 3900, Monte Alegre, 14049-900 Ribeirão Preto, SP Brazil.
authors.forename: Maria Ep
authors.initials: ME
authors.lastname: Nardim
authors.affiliation: Department of Surgery, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP Brazil.
authors.forename: Sylvio
authors.initials: S
authors.lastname: Tucci
authors.affiliation: Department of Physiology, Faculty of Medicine of Ribeirão Preto, São Paulo University, Ribeirão Preto, SP Brazil.
authors.forename: Heloísa Dc
authors.initials: HD
authors.lastname: Francescato
authors.affiliation: Department of Physiology, Faculty of Medicine of Ribeirão Preto, São Paulo University, Ribeirão Preto, SP Brazil.
authors.forename: Terezila M
authors.initials: TM
authors.lastname: Coimbra
keywords: Kidney transplantation; Macrophages; Renal failure; Urinary monocyte chemoattractant protein-1 (uMCP-1)