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Acute renal allograft rejection is associated with increased levels of vascular endothelial growth factor in the urine
Author(s) -
PENG WENHAN,
CHEN JIANGHUA,
JIANG YUGUANG,
SHOU ZHANGFEI,
CHEN YING,
WANG HUIPING
Publication year - 2008
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2007.00856.x
Subject(s) - medicine , urine , urology , vascular endothelial growth factor , vegf receptors
SUMMARY: Aim: The purpose of this study was to assess whether measurement of urinary vascular endothelial growth factor (VEGF) could be adopted as a new non‐invasive diagnostic tool for acute rejection following renal transplantation. Methods: Urinary concentration of VEGF was determined by an enzyme‐linked immunosorbent assay technique in 215 renal allograft recipients and 80 healthy controls. Results: Subjects with acute rejection ( n = 67) excreted urinary VEGF at a significantly higher level (28.57 ± 6.21, 95% CI: 16.18–40.97 pg/μmol creatinine) than those without acute rejection. This included subjects with stable renal function and no abnormal histological findings ( n = 119), acute tubular necrosis ( n = 15), chronic allograft nephropathy ( n = 14) and healthy controls ( n = 80). Using a urinary VEGF/creatinine ratio of 3.64 pg/μmol as the cut‐off point, the sensitivity and specificity for diagnosing acute rejection were 85.1 and 74.8%, respectively ( P < 0.001). Patients with steroid‐resistant acute rejection had significantly greater urinary VEGF concentration than patients with steroid‐sensitive acute rejection (42.09 ± 10.00 vs 9.74 ± 2.63 pg/μmol creatinine, P < 0.001). Patients with graft loss after acute rejection had significantly greater urinary VEGF concentration than patients with reversible acute rejection (106.66 ± 38.60 vs 19.46 ± 4.13 pg/μmol creatinine, P = 0.001). Using a urinary VEGF/creatinine ratio of 22.48 pg/μmol as the cut‐off point, the sensitivity and specificity of the prediction to graft loss after acute rejection were 85.7% and 78.3%, respectively ( P = 0.001). Conclusion: This study demonstrates that the monitoring of urinary VEGF may be a useful non‐invasive approach for the detection of acute rejection. Additionally, urinary VEGF levels were shown to predict the response to anti‐rejection therapy and to predict a poor outcome after acute rejection.