title: Serum Lactate Dehydrogenase is Elevated in Ischemic Acute Tubular Necrosis but Not in Acute Rejection in Kidney Transplant Patients.
abstract: Serum lactate dehydrogenase (LDH) levels may help to distinguish ischemic acute tubular necrosis (ATN) from acute rejection after kidney transplantation.
  
  
  
  All kidney biopsies performed in the years 2010 to 2012 were reviewed. Serum LDH, creatinine level, clinical variables, and presence of donor-specific antibodies were recorded before the biopsy.
  
  
  
  Overall 150 biopsies were included. Ischemic ATN was diagnosed in 45 biopsies and acute cellular-mediated rejection and/or antibody-mediated rejection in 59 biopsies, 38 of which were accompanied by ATN. Serum LDH was elevated in 23 (51%) of 45 cases with ischemic ATN versus 15 (14%) of 105 cases with other diagnoses ( P < .0001). Median serum LDH was 478 U/L (range 277-2018) for ischemic ATN and 372 U/L (range 191-748) for all other diagnoses ( P < .001). When delayed graft function or primary nonfunctioning grafts were caused by ischemic ATN, serum LDH was elevated in 58% of cases, but when caused by acute rejection, LDH was normal in 88% of cases ( P = .02).
  
  
  
  There is a strong association between elevated serum LDH 1 to 3 days before performing kidney biopsy and the diagnosis of ischemic ATN after kidney transplantation, especially at the immediate posttransplantation period. Normal serum LDH at this period should raise a suspicion of acute rejection.
authors.affiliation: 1 Department of Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.|2 Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.|3 Sackler Medical School, Tel-Aviv University, Israel.
authors.forename: Hefziba
authors.initials: H
authors.lastname: Green
authors.affiliation: 3 Sackler Medical School, Tel-Aviv University, Israel.|4 Department of Pathology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
authors.forename: Ana
authors.initials: A
authors.lastname: Tobar
authors.affiliation: 3 Sackler Medical School, Tel-Aviv University, Israel.|5 Department of Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Gafter-Gvili
authors.affiliation: 3 Sackler Medical School, Tel-Aviv University, Israel.|6 Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Leonard
authors.initials: L
authors.lastname: Leibovici
authors.affiliation: 3 Sackler Medical School, Tel-Aviv University, Israel.|7 Tissue Typing Laboratory, Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Tirza
authors.initials: T
authors.lastname: Klein
authors.affiliation: 2 Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.|3 Sackler Medical School, Tel-Aviv University, Israel.
authors.forename: Ruth
authors.initials: R
authors.lastname: Rahamimov
authors.affiliation: 3 Sackler Medical School, Tel-Aviv University, Israel.|8 Department of Transplantation, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
authors.forename: Eytan
authors.initials: E
authors.lastname: Mor
authors.affiliation: 3 Sackler Medical School, Tel-Aviv University, Israel.|6 Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Grossman
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D005260:Female; D006084:Graft Rejection / Q000201:enzymology*; D006801:Humans; D016030:Kidney Transplantation; D007683:Kidney Tubular Necrosis, Acute / Q000201:enzymology*; D045022:Lactate Dehydrogenases / Q000097:blood*; D008297:Male; D008875:Middle Aged
chemical_list: D015415:Biomarkers; D045022:Lactate Dehydrogenases
keywords: acute rejection; acute tubular necrosis; kidney transplantation; lactate dehydrogenase