Simple urine test detects common causes of kidney dysfunction after transplantation

Test could possibly replace invasive biopsies to help guide treatment

2014-03-07

(Press-News.org) Washington, DC (March 6, 2014) — A new noninvasive urine test can distinguish among different causes of acute kidney dysfunction after transplantation. The test, which is described in a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN), may allow patients to avoid invasive kidney biopsies when their transplanted organ is not functioning properly.

When creatinine levels are elevated in the blood of a kidney transplant recipient, it is an indication that the transplanted kidney is not functioning well. There are several reasons for transplant kidney dysfunction, and none of the blood or urine tests can reliably differentiate them. Because it is important to establish the exact reason for kidney dysfunction in order to determine the appropriate treatment, physicians typically perform a needle biopsy of the transplanted kidney.

Now, however, Thangamani Muthukumar, MD (Weill Medical College of Cornell University) and his colleagues have developed a urine test that measures the levels of several messenger RNAs (mRNAs) that are directly related to the disease processes that cause kidney dysfunction. The researchers measured absolute levels of mRNAs in 84 urine samples from 84 kidney transplant recipients who had undergone needle biopsy of the transplanted kidney to determine the cause of their acute kidney dysfunction.

"Using statistical methods we have combined the mRNAs to yield a diagnostic signature," explained Dr. Muthukumar. The researchers developed two such signatures from cells found in the urine that could differentiate, in a two-step approach, the common causes of acute kidney dysfunction with high accuracy.

"Our study shows that when the creatinine level is elevated in the blood of a kidney transplant recipient, use of our urine test would differentiate the common causes of kidney dysfunction that led to the elevation in creatinine, hence benefiting many patients by allowing them to avoid the need for an invasive needle biopsy," said Dr. Muthukumar.

INFORMATION: Highlights A new urine test can distinguish among different causes of kidney dysfunction in kidney transplant recipients. If validated in larger multicenter study, the test may allow patients to avoid invasive kidney biopsies. Kidney dysfunction is a common complication after transplantation. The first author of the study is Dr. Marie Matignon, MD. Study co-authors include Ruchuang Ding, MD, Darshana M. Dadhania, MD, Franco B. Mueller, MD, Choli Hartono, MD, Catherine Snopkowski, Carol Li, John R. Lee, MD, Daniel Sjoberg MA, Surya V. Seshan, MD, Vijay K. Sharma, PhD, Hua Yang, MD, Bakr Nour, MD, Andrew J. Vickers, PhD, and Manikkam Suthanthiran, MD.

Disclosures: The authors reported no financial disclosures.

This work was supported, in part, by an award from the Assistance Publique-Hôpitaux de Paris and Institut Fédératif de Recherche en Néphrologie et Transplantation (IFRNT), France (to Marie Matignon), Qatar National Research Foundation Award NPRP 08-503-3-111 (to Bakr Nour and Manikkam Suthanthiran), National Institutes of Health Grants 2R37-AI051652 (to Manikkam Suthanthiran) and K08-DK087824 (to Thangamani Muthukumar), and Weill Cornell Medical College Clinical and Translational Science Center Award UL1TR000457.

The article, entitled "Urinary Cell mRNA Profiles and Differential Diagnosis of Acute Kidney Graft Dysfunction," will appear online at http://jasn.asnjournals.org/ on March 6, 2014.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 14,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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Simple urine test detects common causes of kidney dysfunction after transplantation

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