Minimum steriod requirements in renal transplant patients monitored by urinary fibrin degradation products and...

The purpose of this study was to define the minimum steroid requirement in patients with a well established renal transplant, monitoring rejection by urinary fibrin degradation products (FDP) and complement (C3) measurements. Urinary FDP and C3 were measured daily over two years in ten patients who had a renal cadaveric transplant. Steroid therapy was reduced step-wise over an average period of fifty weeks to minimum values (range 5--10 mg, mean 7.0 mg prednisone). Three patients developed rejection when taking 7.5 mg prednisone for 10, 21 and 50 weeks respectively. In these three patients urinary FDP excretion rose markedly 12, 10 and 8 weeks respectively prior to the diagnosis of rejection and had fallen to pre-rejection values by the time any significant changes were observed in renal function. C3 appeared in the urine of two of the three patients who had graft rejection, heralding the diagnosis by 14 and 11 days respectively. The minimal steroid dosage varied from 0.06 to 0.24 mg prednisone/kg body weight (mean 0.11) and the three patients who rejected did so on doses of 0.10, 0.13 and 0.16 mg/kg. Doses of prednisone less than 10 mg per day risk the induction of rejection, depending upon the individual response of the patient.