Macpherson N A, Moscarello M A, Goldberg D M, Ish-Shalom N, Arbus G S
Department of Biochemistry, Hospital for Sick Children, Toronto, Ontario.
Clin Invest Med. 1991 Apr;14(2):111-9.
Over 12 months, urine samples were systematically collected from 40 children who underwent renal transplantation for the treatment of end-stage renal disease. Sequential determinations of the excretion of individual amino acids relative to that of creatinine were carried out on 15 subjects. Nine of these (including three who sustained episodes of acute rejection) retained a native kidney in-situ, while in six patients (including three who underwent an episode of acute rejection) both native kidneys had been removed. In both subgroups, the amino acid/creatinine ratios of early morning urine samples were higher shortly before clinical manifestations of acute rejection became evident than in patients who, following renal transplantation, had stable kidney function, chronic graft rejection, or acute tubular necrosis, with one exception: a patient with one native kidney in-situ in whom acute tubular necrosis developed immediately after transplantation. The amino acids showing the greatest increase included Thr, Ser, Gly, and Ala. These values fell dramatically immediately prior to the clinical episode of acute rejection, with Thr, Ala, and Phe showing the most consistent changes. These alterations in urinary amino acid excretion occurred several days before changes in urinary protein excretion or the serum concentrations of urea and creatinine, and may have a role to play in the monitoring of renal transplant recipients.
在12个月的时间里，系统收集了40名接受肾移植治疗终末期肾病儿童的尿液样本。对15名受试者进行了相对于肌酐的单个氨基酸排泄量的连续测定。其中9名（包括3名发生急性排斥反应的患者）原位保留了一个天然肾，而在6名患者（包括3名发生急性排斥反应的患者）中，两个天然肾均已切除。在两个亚组中，急性排斥反应临床表现明显之前不久，晨尿样本的氨基酸/肌酐比值均高于肾移植后肾功能稳定、发生慢性移植排斥反应或急性肾小管坏死的患者，但有一个例外：一名原位保留一个天然肾的患者，移植后立即发生急性肾小管坏死。增加幅度最大的氨基酸包括苏氨酸（Thr）、丝氨酸（Ser）、甘氨酸（Gly）和丙氨酸（Ala）。这些值在急性排斥反应临床发作前立即大幅下降，苏氨酸、丙氨酸和苯丙氨酸（Phe）的变化最为一致。尿氨基酸排泄的这些改变发生在尿蛋白排泄或尿素和肌酐血清浓度变化之前几天，可能在肾移植受者的监测中发挥作用。
