Is Serum Transforming Growth Factor beta-1 Superior to Serum Creatinine for assessing Renal Failure and Renal Transplant Rejection.

ABSTRACT

A sustained overexpression of Transforming Growth Factor beta1 (TGF beta1), a cytokine has been implicated in the pathogenesis of fibrosis of kidney leading to end stage . The main aim of present study was to find the utility of TGF beta1 and serum creatinine in differentiating chronic renal failure (CRF) from acute renal failure (ARF), renal transplant rejection (Tx Rej) and stable renal transplant (Tx Stb) and to study has attempted histopathological correlation of rejection cases with TGF beta1 and serum creatinine. TGF beta1 was determined by using ELISA and serum creatinine was done by autoanalyser. In normal healthy controls (NHC), in majority of cases (80.0%) TGF beta1 was below 25 ng/ml while in 6.0% cases it was upto 34 ng/ml. Rise of TGF beta1 was significant in CRF patients as compared to ARF and NHC (p<0.05) .In rejection cases, TGF beta1 level was significantly raised as compared to NHC and stable graft cases (p<0.05). In rejection cases, it was raised above 40 ng/ml in only 50% cases. In two cases inspite of more than 70% glomerular fibrosis, the patient had TGF beta1 level of only 5 ng/ml and in other three cases of acute cellular rejection the level was 70, 35 and 28 ng/ml respectively.Contrary to it serum creatinine was raised above 2 mg/dl in all cases of transplant rejection but in stable transplant cases in majority (70.6%) it was below 1.5 mg/dl and in 5 cases it was between 1.5 – 1.9 mg/dl.Thus the study suggests that TGF beta1 may not be a good marker for chronic transplant rejection, as it does not correlate well with glomerular fibrosis, probably it is more associated with interstitial inflammation but it can differentiate CRF from ARF if cut off of 40 ng/ml is taken.