TY - JOUR
T1 - Serum lactate dehydrogenase is elevated in ischemic acute tubular necrosis but not in acute rejection in kidney transplant patients
AU - Green, Hefziba
AU - Tobar, Ana
AU - Gafter-Gvili, Anat
AU - Leibovici, Leonard
AU - Klein, Tirza
AU - Rahamimov, Ruth
AU - Mor, Eytan
AU - Grossman, Alon
N1 - Publisher Copyright:
© 2016, NATCO. All rights reserved.
PY - 2017/3
Y1 - 2017/3
N2 - Background: Serum lactate dehydrogenase (LDH) levels may help to distinguish ischemic acute tubular necrosis (ATN) from acute rejection after kidney transplantation. Methods: All kidney biopsies performed in the years 2010 to 2012 were reviewed. Serum LDH, creatinine level, clinical variables, and presence of donor-specific antibodies were recorded before the biopsy. Results: Overall 150 biopsies were included. Ischemic ATN was diagnosed in 45 biopsies and acute cellular-mediated rejection and/or antibody-mediated rejection in 59 biopsies, 38 of which were accompanied by ATN. Serum LDH was elevated in 23 (51%) of 45 cases with ischemic ATN versus 15 (14%) of 105 cases with other diagnoses (P <.0001). Median serum LDH was 478 U/L (range 277-2018) for ischemic ATN and 372 U/L (range 191-748) for all other diagnoses (P <.001). When delayed graft function or primary nonfunctioning grafts were caused by ischemic ATN, serum LDH was elevated in 58% of cases, but when caused by acute rejection, LDH was normal in 88% of cases (P =.02). Conclusions: There is a strong association between elevated serum LDH 1 to 3 days before performing kidney biopsy and the diagnosis of ischemic ATN after kidney transplantation, especially at the immediate posttransplantation period. Normal serum LDH at this period should raise a suspicion of acute rejection.
AB - Background: Serum lactate dehydrogenase (LDH) levels may help to distinguish ischemic acute tubular necrosis (ATN) from acute rejection after kidney transplantation. Methods: All kidney biopsies performed in the years 2010 to 2012 were reviewed. Serum LDH, creatinine level, clinical variables, and presence of donor-specific antibodies were recorded before the biopsy. Results: Overall 150 biopsies were included. Ischemic ATN was diagnosed in 45 biopsies and acute cellular-mediated rejection and/or antibody-mediated rejection in 59 biopsies, 38 of which were accompanied by ATN. Serum LDH was elevated in 23 (51%) of 45 cases with ischemic ATN versus 15 (14%) of 105 cases with other diagnoses (P <.0001). Median serum LDH was 478 U/L (range 277-2018) for ischemic ATN and 372 U/L (range 191-748) for all other diagnoses (P <.001). When delayed graft function or primary nonfunctioning grafts were caused by ischemic ATN, serum LDH was elevated in 58% of cases, but when caused by acute rejection, LDH was normal in 88% of cases (P =.02). Conclusions: There is a strong association between elevated serum LDH 1 to 3 days before performing kidney biopsy and the diagnosis of ischemic ATN after kidney transplantation, especially at the immediate posttransplantation period. Normal serum LDH at this period should raise a suspicion of acute rejection.
KW - Acute rejection
KW - Acute tubular necrosis
KW - Kidney transplantation
KW - Lactate dehydrogenase
UR - http://www.scopus.com/inward/record.url?scp=85016214421&partnerID=8YFLogxK
U2 - 10.1177/1526924816664089
DO - 10.1177/1526924816664089
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AN - SCOPUS:85016214421
SN - 1526-9248
VL - 27
SP - 53
EP - 57
JO - Progress in Transplantation
JF - Progress in Transplantation
IS - 1
ER -