ABSTRACT
Because of some insult to kidney during transplantation, assessment of kidney function after the procedure is essential. It would be ideal to find a marker better than creatinine to early predict the acute kidney injury. To compare with creatinine the predictive value of serum neutrophil gelatinase-associated lipocalin [NGAL] in detecting kidney recovery after renal transplantation. We studied 33 patients who received kidney transplantation [deceased [n=20] and live [n=13]] during a 6-month period in 2010. Serum NGAL and creatinine, hemoglobin, and blood glucose were measured at 0,12, 24,48, and 72 hours after transplantation. The need for dialysis and kidney function in one week were studied. There were 16 men and 17 women with the meantSD age of 36.3 +/- 12.2 [range: 14-58] years. Of the studied patients, 6 had delayed graft function [DGF; hemodialysis within the first week of transplant]; 9 had slow graft function [SGF; serum creatinine reduction from transplantation to day 7 <70%], and 23 had immediate graft function [IGF; reduction in serum creatinine >70%]. At any time, serum NGAL, and creatinine levels were significantly higher among patients with DGF [p=0.024] and SGF [p=0.026] compared with those with IGF. However, in those who got IGF vs non-IGF, serum creatinine levels were not significantly different [p=0.59] but serum NGAL levels differed significantly[p=0.020]. Receiver-operating characteristic [ROC] curve and area under curves [AUCs] of serum NGAL and serum creatinine levels on the first post-transplantation day had similar significance in predicting the patient's need to dialysis in the first week. However, using AUC of serum creatinine was not helpful in predicting non-IGF, compared to serum NGAL. The AUCs of the serum NGAL were 0.70 [95% CI: 0.52-0.89] and 0.76 [95% CI: 0.59-0.93] after 12 and 24 hours, respectively [p<0.05]. The highest AUC [0.82] was attributed to serum NGAL of 24 hour [p=0.002]. Serum NGAL level especially 24 hours post-transplantation, seems to be an early accurate predictor of both the need to dialysis and slow graft function within the first week of kidney transplantation
ABSTRACT
Autosomal-dominant polycystic kidney disease [ADPKD], a common hereditary disease, is characterized by the progressive development and enlargement of multiple cysts in both kidneys, and typically resulting in end stage renal disease [ESRD] by the fifth decade of life. Post-transplant diabetes mellitus [PTDM], a common complication after transplantation with an incidence rate of 2.5-20%, is associated with poor graft and patient survival. In few studies, PTDM has been more frequent in ADPKD transplanted patients. In the present study, we investigated whether there is any association between PTDM and ADPKD in our patients. In this prospective study, 140 non-diabetic and nonsmoker successfully transplanted patients [27 ADPKD and 113 non ADPKD patients] were enrolled during three years. Both groups were matched for age, sex, body mass index [BMI], duration of renal replacement therapy before transplantation and also immunosuppressive protocols after transplant. Post-transplant diabetes mellitus was defined as Clinical Practice Guidelines advocated by Canadian Diabetes Association. All patients were followed for 12 months. PTDM occurred in 11.1% of ADPKD patients and in 13.1% of control group which was statistically insignificant [P > 0.05]. The development of PTDM in ADPKD group was not related to sex, age, and hypertension, duration of renal replacement therapy before transplantation, BMI and serum creatinine levels [P > 0.05]. Post-transplant diabetes mellitus appears not to be associated with autosomal-dominant polycystic kidney disease as an etiology of end stage renal disease