COMBINED USE OF SEVERAL BIOLOGICAL MARKER S (SERUM C-REACTIVE PROTEIN, SERUM NEOPTERIN, AND MICROALBUMINURIA) FOR MONITORING CHILDREN WITH RENAL-TRANSPLANTS - CLINICAL-EXPERIENCE OVER 3 YEARS

Pediatric renal transplant recipients are monitored to ensure early de tection of graft dysfunction and its cause. Serum C-reactive protein, serum neopterin, and urinary microalbumin assays have been routinely u sed by the authors for over three years. C-reactive protein proved the most reliable marker for bacterial infection. Increased microalbuminu ria was sensitive for the early detection of glomerular dysfunction al though its specificity was poor. Serum neopterin levels were evaluated as the serum neopterin/serum creatinine ratio in view of the metaboli sm of neopterin ; this ratio increased during the first few posttransp lantation days then levelled off at 103 +/- 29 and remained stable ove r time in each individual patient. Elevation of the neopterin/creatini ne ratio occurred in macrophage activation due to viral infections or graft rejection. Combined serial use of these three laboratory tests p roved of great assistance for the management of pediatric renal transp lant recipients, especially during the first few months after grafting . In patients with fever and/or elevated serum creatinine levels, micr oalbuminuria was the most sensitive marker for renal dysfunction, CRP was the most sensitive marker for infection, and the neopterin/creatin ine ratio was the most sensitive marker for cytomegalovirus infection (marked elevation reaching 1000 with normal microalbuminuria values) a nd acute graft rejection (N/C ratio elevated but under 500 and increas ed microalbuminuria).