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Sándor Z, Katics D, Varga Á, Kalmár Nagy K, Szakály P. Interpretation of LDH Values after Kidney Transplantation. J Clin Med 2024; 13:485. [PMID: 38256619 PMCID: PMC10816750 DOI: 10.3390/jcm13020485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Kidney transplantation is the gold-standard therapy for end-stage renal disease. However, in the early postoperative period following allograft kidney transplantation, insufficient graft function presents a diagnostic challenge to clinicians. Ischemic damage to the graft and/or an early autoimmune rejection may cause a decrease in function. Ischemic damage is a benign and transient condition, while acute immune rejection requires immediate therapy. A kidney graft ultrasound may produce a false negative result, and graft biopsy is invasive and slow to return results. Serum lactate dehydrogenase (LDH) is under examination as a possible tool for differential diagnosis between ischemic damage and immune rejection. Herein, we analyze the continuous lab results of four patients in the early post-transplantation period, showing patterns correlating with different clinical outcomes and prognoses. In our experience, a persistent elevated LDH accompanies ischemic damage. Immune rejection was, however, associated with a decrease in LDH. Hemodialysis was not a confounding factor, while packed red blood cell transfusion caused severe diagnostic problems.
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Affiliation(s)
- Zoltán Sándor
- Department of Surgery, Clinical Center, University of Pécs, 7624 Pécs, Hungary; (D.K.); (Á.V.)
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Green H, Tobar A, Gafter-Gvili A, Leibovici L, Klein T, Rahamimov R, Mor E, Grossman A. Serum Lactate Dehydrogenase is Elevated in Ischemic Acute Tubular Necrosis but Not in Acute Rejection in Kidney Transplant Patients. Prog Transplant 2016; 27:53-57. [DOI: 10.1177/1526924816664089] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Hefziba Green
- Department of Medicine B, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Medical School, Tel-Aviv University, Israel
| | - Ana Tobar
- Sackler Medical School, Tel-Aviv University, Israel
- Department of Pathology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Anat Gafter-Gvili
- Sackler Medical School, Tel-Aviv University, Israel
- Department of Medicine A, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Leonard Leibovici
- Sackler Medical School, Tel-Aviv University, Israel
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tirza Klein
- Sackler Medical School, Tel-Aviv University, Israel
- Tissue Typing Laboratory, Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Sackler Medical School, Tel-Aviv University, Israel
| | - Eytan Mor
- Sackler Medical School, Tel-Aviv University, Israel
- Department of Transplantation, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Alon Grossman
- Sackler Medical School, Tel-Aviv University, Israel
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
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Lee YJ, Chan JPW, Hsu WL, Lin KW, Chang CC. Prognostic factors and a prognostic index for cats with acute kidney injury. J Vet Intern Med 2012; 26:500-5. [PMID: 22489875 DOI: 10.1111/j.1939-1676.2012.00920.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 01/04/2012] [Accepted: 02/29/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The clinical manifestations of acute kidney injury (AKI) range from mild to fatal in cats; however, prognosis factors have been rarely studied. HYPOTHESIS/OBJECTIVES To find the clinical factors significantly correlated with the outcome among cats with AKI and to develop a simple prognostic index. ANIMALS Seventy cats with AKI were recruited. METHODS Demographic and clinicopathological data obtained from 70 cats with AKI were retrospectively collected. Student's t-test or Mann-Whitney U-test and Pearson chi-square test or Fisher's exact were applied to determine the factors associated with survival in cats with AKI. Using logistic regression, the statistically significant factors associated with prognosis were identified and a new prediction model was generated. RESULTS The overall case fatality rate was 64% (45/70). The results showed that nonsurviving cats had significantly lower levels of PCV, WBC, RBC, LDH and albumin, a lower albumin/globulin ratio, lower blood glucose, and a reduced body temperature, as well as being older. Serum urea and creatinine concentrations were not statistically significant as prognostic factors, but a decrease in these 2 variables in 3 days was significantly related to a reduction in death. A summary prognostic index including body temperature and LDH and albumin concentrations had area under the receiver-operating characteristic curve (AUROC) for predicting death of 0.86 (P < .05) and a cut-off value of 0.82, a sensitivity of 77% and a specificity of 90%. CONCLUSIONS The prognosis in cats with AKI is quite different from that found for human and dogs.
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Affiliation(s)
- Y-J Lee
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 402, Taiwan
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