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Abstract
An evaluation of the usefulness of urinary N-acetyl-beta-D-glucosaminidase (NAG) and
aminopeptidase N (AAP) measurements in the diagnosis and prediction of acute and chronic
renal allograft rejection was made. Enzyme activities were measured in 2,745 morning
spot urine samples from 53 consecutive live donor renal allograft recipients up to
180 days after transplantation. Reference ranges of urinary enzyme activities in 14
recipients with normal graft function were higher than those established in a carefully
selected group of healthy controls. 89 and 91% of 76 clinically diagnosed acute rejection
episodes (ARE) in the remaining 39 graft recipients were accompanied by sharp increase
over baseline of NAG and AAP respectively. All rejection episodes occurring in the
early period after transplantation were characterised by high enzymuria. AAP was more
sensitive than NAG as the magnitude of its increase over baseline was more, while
NAG was more specific with less number of false positive elevations. Both enzymes
were found to be equally good prognostic indices of graft loss and chronic graft deterioration.
Regular monitoring of urinary NAG and AAP activities throughout the post transplant
period would thus be valuable in (a) diagnosis and prediction of ARE in the early
as well as late post operative period and (b) prediction of eventual graft outcome.