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Urinary nitrate concentration as a marker for kidney transplant rejection
Amy Riddell1, John Kirkwood2, Miranda Smallwood3
1Institute of Biomedical and Clinical Sciences, University of Exeter, and NIHR Exeter Clinical Research Facility, Exeter, Devon, UK. Amy.Riddell@nhs.net.
BMC Nephrology
|October 21, 2020
Summary
This study found that urinary nitrate to creatinine ratio (uNCR) does not effectively predict kidney transplant rejection. Researchers concluded that uNCR is not a useful biomarker for monitoring transplant health.
Area of Science:
- Nephrology
- Transplant Immunology
- Biomarker Discovery
Background:
- Early detection of kidney transplant rejection is crucial for graft survival and recipient health.
- Current methods rely on creatinine levels, often indicating rejection after significant damage has occurred.
- A novel biomarker for earlier rejection detection could significantly improve patient outcomes.
Purpose of the Study:
- To investigate the potential of urinary nitrate concentration as an early biomarker for renal transplant rejection.
- To assess if urinary nitrate to creatinine ratio (uNCR) can predict rejection episodes in contemporary clinical practice.
Main Methods:
- A prospective observational study collected 2656 urine samples from renal transplant recipients over 18 months.
- Urinary nitrate to creatinine ratio (uNCR) was measured and compared between groups: routine care, biopsy-proven rejection, biopsy-proven no rejection, and other callbacks.
- Statistical analysis, including ANOVA, was used to compare uNCR values across groups and over time within patients.
Main Results:
- No significant difference was found in uNCR between patients with biopsy-proven rejection and those without (p=0.55 and p=0.77).
- Overall uNCR exhibited high variability, lacking a diagnostic threshold for kidney transplant rejection.
- Within-patient uNCR also showed significant variability over time, precluding individualized patient monitoring for rejection.
Conclusions:
- The urinary nitrate to creatinine ratio (uNCR) is not a reliable biomarker for detecting or predicting renal transplant rejection.
- The high variability of uNCR limits its clinical utility in transplant management.
- Further research into alternative biomarkers is warranted for early detection of transplant rejection.
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