The Value of Laboratory Diagnostics of Acute Renal Graft Rejection Compared to the Goldstandard Transplant Biopsy

The main problem of organ transplantation is acute rejection and its therapy. Clinical symptoms (oliguria, hypertension, pain in the transplant, fever, weight gain) and laboratory chemical/histological findings are possible signs of a rejection after kidney transplantation. A suspicion for a rejection is firstly expressed by finding clinical signs. The laboratory chemistry and the histology prove this suspicion true or not. Deviate findings in laboratory chemistry and histology are possible. In the years 2003-2006 58 patients who received a renal allograft had a transplant biopsy due to a suspected acute rejection. The laboratory measurements especially the c-reactive protein in urine are measured. For therapy the patients received 500 mg methylprednison over 3-7 days. If there was a steroid-resistent rejection we applicated ATG or ALG. In 58 patients there was at least one clinical sign for acute rejection. In this patients, 76 biopsies were performed. In 11 cases we found a histologically proven acute rejection. 40 patients were successful treated with methylprednisolon. From this 40 patients we found only in 10 patients a histologically proven acute rejection. In 75% of these 40 patients an increase of c-reactive protein in the urine was detected. 50% with increase of c-reactive protein in the urine had no histological findings for acute rejection. In 25% the increase of c-reactive protein and histology were positive for acute rejection. In other 25% the c-reactive protein and histology were negative. Our results show, that c-reactive protein in the urine is a better marker for rejection than histology.