DIFFICULTIES IN EVALUATING URINALYSIS FOLLOWING COMBINED PANCREAS-KIDNEY TRANSPLANTATION

Combined pancreas-kidney transplantation has been introduced in the tr eatment of patients with type I diabetes and renal failure 20 years ag o. Bq 1985 374 combined pancreas-kidney transplantations had been repo rted to the International Pancreas Transplant Registries.(1) Surgical drainage of the transplanted exocrine pancreas into the urinary bladde r solves most of the postoperative problems encountered with the exocr ine secretions. Furthermore. monitoring of pancreatic enzyme (amylase) activity in urine hus been shown to be useful in diagnosis oi rejecti on of thr pancreatic graft.(2) However, little attention has been paid to the biochemical consequences of high activities of proteolytic pan creatic enzymes on the determination of urinary proteins. The present case illustrates the difficulties in interpreting proteinuria in patie nts with combined pancreas-renal transplant with pancreaticocystostomi a. In the propositus, interpretation of the urinary protein electropho resis is hampered by the presence oi pancreatic juice proteins and pep tides originating from digestion of proteins by activated pancreatic e nzymes. Results of immunochemically determined marker proteins ([micro ]albumin. transferrin. beta 2-microglobulin) are unreliable due to dig estion by pancreatic enzymes.