Urinary C-peptide: unsuitable parameter of beta-cell secretion in pancreas transplantation

Difficulties in evaluating urinalysis following combined pancreas-kidney transplantation

Combined pancreas-kidney transplantation has been introduced in the treatment of patients with type 1 diabetes and renal failure 20 years ago. By 1985 374 combined pancreas-kidney transplantations had been reported to the International Pancreas Transplant Registries. Surgical drainage of the transplanted exocrine pancreas into the urinary bladder solves most of the postoperative problems encountered with the exocrine secretions. Furthermore, monitoring of pancreatic enzyme (amylase) activity in urine has been shown to be useful in diagnosis of rejection of the pancreatic graft. However, little attention has been paid to the biochemical consequences of high activities of proteolytic pancreatic enzymes on the determination of urinary proteins. The present case illustrates the difficulties in interpreting proteinuria in patients with combined pancreas-renal transplant with pancreaticocystostomia. In the propositus, interpretation of the urinary protein electrophoresis is hampered by the presence of pancreatic juice proteins and peptides originating from digestion of proteins by activated pancreatic enzymes. Results of immunochemically determined marker proteins ([micro]albumin, transferrin, beta 2-microglobulin) are unreliable due to digestion by pancreatic enzymes.

Successful pregnancy after combined pancreas-kidney transplantation

In this paper we report a successful pregnancy after combined pancreas-kidney transplantation. During pregnancy the patient was treated with prednisone and cyclosporin. Pancreatic and renal function remained normal during pregnancy, but moderate hypertension was detected in the 28th week. A healthy baby of 1900 g (below the tenth percentile) was born at 36 weeks. In this case, urine pregnancy tests were negative throughout the pregnancy, probably due to the exocrine secretion of the pancreas, which had been diverted to the urinary bladder. This possibility has not been previously reported.