C. Reek et al., Do serum C-reactive protein measurements help to discriminate episodes of renal dysfunction in patients after renal transplantation?, CLIN CHIM A, 310(1), 2001, pp. 57-61
Introduction: This study investigated whether serial daily measurements of
serum C-reactive protein (sCRP) could help differentiate episodes of transp
lant dysfunction due to rejection, infection, cyclosporine A (CsA) nephroto
xicity, or acute tubular necrosis (ATN) in renal-allograft recipients. Mate
rials and Methods: Morning serum was obtained daily from 134 patients durin
g the first 30 days after renal transplantation. All episodes of graft dysf
unction were recorded and differentiated with transplant biopsies. CRP conc
entrations were correlated with post-operative graft function and the vario
us causes of graft dysfunction. Results: All patients showed an increase in
sCRP in response to surgery, with a maximum on day 2 after transplantation
. The sCRP concentration was significantly higher in patients with delayed
graft function (mean 61.50 mug/ml) than in patients with primary graft func
tion (mean 38.01 mug/ml) (p=0.001). Bacterial infections other than asympto
matic bacteriuria (mean sCRP 33.98 mug/ml), interstitial graft rejection (m
ean sCRP 16.43 mug/ml), and ATN (mean sCRP 30.50 mug/ml) were accompanied b
y significant increases in sCRP compared with uneventful courses. sCRP was
unchanged in the presence of viral infections or CsA toxicity. Conclusion:
Serial sCRP measurements help to identify renal-transplant dysfunction of d
ifferent origins. However, rejection, infection and ATN show similar patter
ns of sCRP increase. Thus, sCRP is unable to discriminate the causes of ren
al-graft dysfunction. Biopsy remains the gold standard for the differential
diagnosis of renal-allograft dysfunction. (C) 2001 Elsevier Science BN. Al
l rights reserved.