title: Urinary Calprotectin Differentiates Between Prerenal and Intrinsic Acute Renal Allograft Failure.
abstract: BACKGROUND
  Urinary calprotectin has recently been identified as a promising biomarker for the differentiation between prerenal and intrinsic acute kidney injury (AKI) in the nontransplant population. The present study investigates whether calprotectin is able to differentiate between these 2 entities in transplant recipients as well.
  
  
  METHODS
  Urinary calprotectin was assessed by enzyme-linked immunosorbent assay in 328 subjects including 125 cases of intrinsic acute allograft failure, 27 prerenal graft failures, 118 patients with stable graft function, and 58 healthy controls. Acute graft failure was defined as AKI stages 1 to 3 (Acute Kidney Injury Network criteria), exclusion criteria were obstructive uropathy, urothelial carcinoma, and metastatic cancer. The clinical differentiation of prerenal and intrinsic graft failure was performed either by biopsy or by a clinical algorithm including response to fluid repletion, history, physical examination, and urine dipstick examination.
  
  
  RESULTS
  Reasons for intrinsic graft failure comprised rejection, acute tubular necrosis, urinary tract infection/pyelonephritis, viral nephritis, and interstitial nephritis. Calprotectin concentrations of patients with stable graft function (50.4 ng/mL) were comparable to healthy controls (54.8 ng/mL, P = 0.70) and prerenal graft failure (53.8 ng/mL, P = 0.62). Median urinary calprotectin was 36 times higher in intrinsic AKI (1955 ng/mL) than in prerenal AKI (P < 0.001). Receiver-operating characteristic curve analysis revealed a high accuracy of calprotectin (area under the curve, 0.94) in the differentiation of intrinsic versus prerenal AKI. A cutoff level of 134.5 ng/mL provided a sensitivity of 90.4% and a specificity of 74.1%. Immunohistochemical stainings for calprotectin in renal allograft biopsy specimens confirmed the serological results.
  
  
  CONCLUSIONS
  Urinary calprotectin is a promising biomarker for the differentiation of prerenal and intrinsic acute renal allograft failure.
authors.affiliation: 1 Medical Department 1, Universitätsklinikum Marien Hospital Herne, Ruhr-University of Bochum, Germany. 2 Department of Nephrology, Charité-Campus Benjamin Franklin, Berlin, Germany. 3 Department of Nephrology, Charité-Campus Mitte, Berlin, Germany. 4 Medical Clinic I, Clinic of Cologne, Cologne, Germany.
authors.forename: Felix S
authors.initials: FS
authors.lastname: Seibert
authors.forename: Christian
authors.initials: C
authors.lastname: Rosenberger
authors.forename: Susanne
authors.initials: S
authors.lastname: Mathia
authors.forename: Robert
authors.initials: R
authors.lastname: Arndt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Arns
authors.forename: Huppertz
authors.initials: H
authors.lastname: Andrea
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Pagonas
authors.forename: Frederic
authors.initials: F
authors.lastname: Bauer
authors.forename: Walter
authors.initials: W
authors.lastname: Zidek
authors.forename: Timm H
authors.initials: TH
authors.lastname: Westhoff
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000652:urine*; D000368:Aged; D064591:Allografts; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D001706:Biopsy; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005858:Germany; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology / Q000652:urine*; D006085:Graft Survival; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000378:metabolism* / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects*; D039841:Leukocyte L1 Antigen Complex / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D017211:Treatment Failure; D016482:Urinalysis
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex