Beta-2-microglobulin for differentiation between ciclosporin A nephrotoxicity and graft rejection in renal transplant recipients

The clinical relevance of daily measurement of beta 2-microglobulin in serum and urine was evaluated in 49 patients undergoing renal transplantation. The changes in beta 2-microglobulin levels were compared to standard parameters for assessment of renal function. One hundred episodes of acute deteri...

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Published inNephron (2015) Vol. 51; no. 3; p. 330
Main Authors Prischl, F, Gremmel, F, Schwabe, M, Schindler, J, Balcke, P, Kopsa, H, Pinter, G, Schwarzmeier, J, Zazgornik, J
Format Journal Article
LanguageEnglish
Published Switzerland 1989
Subjects
Acute Disease
Adolescent
Adult
beta 2-Microglobulin - analysis
beta 2-Microglobulin - urine
Blood Urea Nitrogen
Creatinine - urine
Cyclosporins - adverse effects
Diagnosis, Differential
Female
Graft Rejection
Humans
Kidney - drug effects
Kidney Diseases - chemically induced
Kidney Diseases - diagnosis
Kidney Transplantation
Male
Middle Aged
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Summary:The clinical relevance of daily measurement of beta 2-microglobulin in serum and urine was evaluated in 49 patients undergoing renal transplantation. The changes in beta 2-microglobulin levels were compared to standard parameters for assessment of renal function. One hundred episodes of acute deterioration of renal function, clinically diagnosed as rejection, were analyzed retrospectively: (1) In 18 episodes renal malfunction did not respond to methylprednisone but improved immediately upon dose reduction of ciclosporin A, thus indicating a nephrotoxic effect of the drug. In these cases a mean increase of beta 2-microglobulin in urine as high as 7.9 mg/l was observed while serum values decreased. (2) Fifty episodes of apparent rejection (responsive to steroids) were preceded by a 3-day lasting continuous rise of beta 2-microglobulin in serum of up to 3.6 mg/l as a mean with only a moderate elevation in urine. (3) In 13 episodes antirejection treatment could have been avoided as continuously declining laboratory parameters indicated spontaneous improvement of renal function. We conclude that parallel determination of beta 2-microglobulin in serum and urine allows to differentiate between ciclosporin A nephrotoxicity and rejection in 91% of the cases.
ISSN:1660-8151
DOI:10.1159/000185318