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Enzymuria and low molecular weight protein excretion as the differentiating marker of complications in the early post kidney transplantation period

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Renal function in the early post-transplantation period depends largely on factors affecting the kidney prior to implantation. Function of the graft may be also disturbed by the most common complications of the early post-operative period such as acute graft rejection (AGR), acute tubular necrosis (ATN) and may be modified by nephrotoxic action of cyclosporine A (CsA). Evaluation of excretion of enzymes and low molecular weight proteins (LMWP) may help in the differentiation of these complications.

Aim Comparison of the urinary excretion of markers of tubular injury in patients with AGR, ATN, or patients with stable graft function (SGF) was made and differences between groups and correlations between markers and cold ischemia time (CIT), warm ischemia time (WIT) and blood trough level of cyclosporine A (CsA0) were determined.

Material and methods In 60 cadaveric renal allograft recipients in the early post-transplantation period urinary excretion of N-acetyl-β-d-glucosaminidase (NAG) and B isoenzyme (NAG-B), alanylaminopeptidase (AAP), γ-glutamyltransferase (GGT), α and π isoenzymes of glutathione S-transferase (α-GST, π-GST), retinol binding protein (RBP) and β2- microglobulin (β2M), were analyzed.

Results NAG and NAB-B activities were higher in ATN (P<0.05, P<0.01) and in AGR (P<0.005, P<0.02) than in SGF. Excretion of π-GST was higher in AGR than in SGF (P<0.0002) or ATN (P<0.007). CIT and WIT in patients with ATN were higher (P<0.05) than in SGF group. In ATN patients, correlations of CIT with RBP (P<0.05) and π-GST (P<0.05), and WIT with RBP (P<0.05), and π-GST (P<0.001) were found.

Conclusions High urinary NAG and NAG B excretion characterizes ATN and AGR patients. Evaluating urinary excretion of π-GST may be helpful in differentiating AGR from ATN. However, taking into account ischemia time is necessary in interpreting the π-GST value in early post transplant period.

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Acute graft rejection


Acute tubular necrosis


Stable graft function


Cyclosporine A

CsA0 :

Level of cyclosporine A in blood


Cold ischemia time


Warm ischemia time




Isoenzyme NAG





α-GST, π-GST:

α and π isoenzymes of glutathione S-transferase


Retinol binding protein




Low molecular weight proteins


  1. 1.

    Kuźniar J, Marchewka Z, Lembas-Bogaczyk J, Kuźniar TJ, Klinger M (2004) Etiology of increased enzymuria in different morphological forms of glomerulonephritis. Nephron 98:8–14

  2. 2.

    Falloon J, Gallin JI (1986) Neutrophil granules in health and disease. J Allergy Clin Immunol 77:653

  3. 3.

    Jung K, Diego J, Strolbelt V, Scholtz D, Schreiber G (1986) Diagnostic significance of some urinary enzymes for detecting acute rejection crises in renal-transplant recipients: alanine aminopeptidase, alkaline phosphatase, gamma-glutamyl-transferase, N-acetyl-β-d-glucosaminidase and lysozyme. Clin Chem 32:1807–1811

  4. 4.

    Mueller PW, Delaney V, MacNeil ML, Caudill SP, Steinberg KK (1990) Indicators of acute renal-transplant rejection in patients treated with cyclosporine. Clin Chem 36:759–764

  5. 5.

    Bornstein B, Arenas J, Morales JM et al (1996) Cyclosporine nephrotoxicity and rejection crisis: diagnosis by urinary enzyme excretion. Nephron 72:402–406

  6. 6.

    Backman L, Appelkvist EL, Ringden O, Dallner G (1988) Glutathione transferase in the urine: a marker for post-transplant tubular lesions. Kidney Int 33:571–577

  7. 7.

    Polak WP, Kosieradzki M, Kwiatkowski A et al (1999) Activity of Glutathione S-transferases in the urine of kidney transplant recipients during the first week after transplantation. Ann Transpl 4:42–45

  8. 8.

    Price RG (1982) Urinary enzymes, nephrotoxicity and renal disease. Toxicology 23:99–134

  9. 9.

    Schardijn GHC, Statius van Eps LW (1987) Statius van Eps. β2-microglobulin: its significance in the evaluation of renal function. Kidney Int 32:635–641

  10. 10.

    Nishi S, Kouda Y, Miyazaki S, Hirasawa Y (1992) What is a true cause of high level of urinary beta 2-microglobulin after renal transplantation. Nephron 61:485–486

  11. 11.

    Leaback DH, Walker PG (1961) The fluorimetric assay of NAG. Biochem J 78:151–163

  12. 12.

    Haschen RJ (1970) Enzymodiagnostic. VEB Gustaw Fischer, Jena

  13. 13.

    Bourbouze R, Gluckman JC, Frantz P et al (1985) Early monitoring of human renal transplantations N-acetyl-beta-d-glucosaminidase isoenzyme activities in urines. Clin Chim Acta 149:185–195

  14. 14.

    Whiting PH, Nicholls AJ, Catto GRD, Edward N, Engeset J (1980) Patterns of N-acethyl-β-d-glucosaminidase excretion after renal transplantation. Clin Chim Acta 108:1–7

  15. 15.

    Matteucci E, Carmellini M, Bertoni C, Boldrini E, Mosca F, Giampieli O (1998) Urinary excretion rates of multiple renal indicators after kidney transplantation: clinical significance for early graft outcome. Ren Fail 20:325–330

  16. 16.

    Sundberg AGM, Appelkvist E-L, Bacman L, Dallner G (1994) Urinary π-class glutathione transferase as an indicator of tubular damage in the human kidney. Nephron 67:308–316

  17. 17.

    Donadio C, Puccini R, Lucchesi A, Giorfdani R, Rizzo G (1998) Urinary excretion of proteins and tubular enzymes in renal transplant patients. Ren Fail 20:707–715

  18. 18.

    Marchewka Z, Kuźniar J, Długosz A (1999) Enzymatic markers of cyclosporine nephrotoxicity in patients after renal transplantation. Intern Urol Nephrol 31:727–734

  19. 19.

    Tataranni G, Zavagli G, Farinelli R et al (1992) Usefulness of the assessment of urinary enzymes and microproteins in monitoring ciclosporin nephrotoxicity. Nephron 60:314–318

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Correspondence to Jakub Kuźniar.

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Kuźniar, J., Marchewka, Z., Krasnowski, R. et al. Enzymuria and low molecular weight protein excretion as the differentiating marker of complications in the early post kidney transplantation period. Int Urol Nephrol 38, 753–758 (2006). https://doi.org/10.1007/s11255-006-0052-z

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  • Acute graft rejection
  • Acute tubular necrosis
  • Cyclosporine A nephrotoxicity
  • Enzymuria
  • Ischemia time
  • Low molecular weight protein