Russo Luigi, Carrano Rosa, Corso Gaetano, Dello Russo Antonio, Gelzo Monica, Napolitano Paola, Federico Stefano, Russo Domenico
G Ital Nefrol. 2014 Nov-Dec;31(6).
Kidney transplantation is frequently complicated by delayed graft function (DGF). DGF is associated with more frequent rejection episodes, increased need of post-transplantation biopsies, dialysis sessions and prolonged hospitalization. These complications may have negative impact on long-term survival of transplanted kidney.Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is regarded as acute kidney injury marker.This preliminary study aimed at evaluating whether uNGAL may be early predictor of DGF in kidney transplanted patients.
Urine samples were collected from renal transplant recipients on day 1 post-transplantation to determine 24/h urinary NGAL and creatinine excretion. On same day, routine blood chemistry was assessed.
N. 20 renal transplant recipients were evaluated. DGF was observed in n. 6 patients (DGF-patients). In DGF-patients compared to NO-DGF-patients, mean age was higher (586 Vs 5111, p=0.001), while 24/h urine output (5735 Vs 4150 2230 ml/24h; p=0.001) and urinary creatinine excretion (191184 Vs 683660 mg/24h; p=0.001) were lower. No difference was found between DGF- and NO-DGF-patients in 24/h urinary NGAL excretion (1,202,20 Vs 2,444,0 mg/24h; p<0.20). In univariate analysis, DGF was inversely associated to 24/h urine output (r2=-0.795, p=0.001) and urinary creatinine excretion (r2=-0.480, p=0.037) and positively to age (r2=0.446, p=0.049). In multivariate analysis 24/h urine output (p=0.014) and 24/h urinary creatinine excretion (p=0.039) were associated to DGF.
This preliminary study suggests that 24/h urinary NGAL excretion, measured 1 day after kidney transplantation, is not a reliable predictor of DGF. Larger study with longer observation period is mandatory.
肾移植常并发移植肾功能延迟恢复（DGF）。DGF与更频繁的排斥反应、移植后活检需求增加、透析次数增多及住院时间延长相关。这些并发症可能对移植肾的长期存活产生负面影响。尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）被视为急性肾损伤标志物。本初步研究旨在评估uNGAL是否可能是肾移植患者DGF的早期预测指标。
在肾移植受者移植后第1天收集尿液样本，以测定24小时尿NGAL和肌酐排泄量。同一天，评估常规血液生化指标。
对20例肾移植受者进行了评估。6例患者出现DGF（DGF组患者）。与非DGF组患者相比，DGF组患者的平均年龄更高（58.6岁对51.1岁，p = 0.001），而24小时尿量（573.5对4150±2230ml/24小时；p = 0.001）和尿肌酐排泄量（1911.84对6836.60mg/24小时；p = 0.001）更低。DGF组和非DGF组患者24小时尿NGAL排泄量无差异（1202.20对2444.0mg/24小时；p<0.20）。在单因素分析中，DGF与24小时尿量（r² = -0.795，p = 0.001）和尿肌酐排泄量（r² = -0.480，p = 0.037）呈负相关，与年龄呈正相关（r² = 0.446，p = 0.049）。在多因素分析中，24小时尿量（p = 0.014）和24小时尿肌酐排泄量（p = 0.039）与DGF相关。
本初步研究表明，肾移植后1天测定的24小时尿NGAL排泄量不是DGF的可靠预测指标。必须进行观察期更长的更大规模研究。
