A preliminary study on the significant value of beta-2-microglobulin over serum creatinine in renal transplant rejection and renal failure

INTRODUCTION

Beta-2-microglobulin (beta2M) is a light chain of HLA class I molecule, which is filtered by glomerulus, reabsorbed and catabolised by proximal tubule. It is one of the markers of transplant rejection. The aim of the present study was to find out the level of beta2M in acute renal failure (ARF), chronic renal failure (CRF), renal transplant rejection (TR) and renal transplantation stable (TS) cases, and correlation of beta2M with serum creatinine (SCr) in assessing renal failure.

METHODS

23 patients with ARF, 22 patients with CRF, six cases of TR, seven patients with TS, and 28 normal healthy controls were studied within a one-year period.

RESULTS

Highest mean value of beta2M was noted (12.97 +/- 3.83 microg/ml) in CRF, and all cases had elevated beta2M of which 81.8 percent of cases had beta2M above 10 microg/ml. In ARF, all cases had elevated beta2M and 78.3 percent patients had a value more than 10 microg/ml with a mean value of 11.75 +/- 2.09 microg/ml. TR cases also had elevated beta2M but 50 percent had mild elevation (less than 10 microg/ml) and 50 percent had marked elevation (more than 10 microg/ml). 42.8 percent of TS patients also had mild elevation of beta2M in the range 2.10-3.70 microg/ml. Interestingly, in normal healthy controls, 21.4 percent of patients had mild elevation of beta2M of 2.1-2.75 microg/ml, while 78.6 percent of cases had a normal range of beta2M (less than 2 microg/ml). All normal healthy controls and 71.4 percent of TS cases had normal SCr (less than 1.4 mg/dL). All cases of CRF and TR cases, and 28.6 percent of TS cases had elevated SCr. 81.8 percent of cases with CRF and 60.9 percent of cases with ARF had a marked rise of serum creatinine above 5 mg/dL.

CONCLUSION

Our study showed that beta2M is not superior over SCr for renal failure and TR cases, because it is also elevated in 21.4 percent of normal controls and 42.8 percent of TS cases. SCr is a cheaper, simpler and comparatively good test to assess renal failure and TR.

Is HLA-B27 a useful test in the diagnosis of juvenile spondyloarthropathies?

INTRODUCTION

Seronegative spondyloarthritis (SSA) is a type of arthritis that involves joints in the spine, as well as the hips, shoulders, knees and ankles. The diagnosis of juvenile spondyloarthritis is rarely entertained in young children who present with back and leg pain. The aim of the present study was to assess the role of HLA-B27 as a diagnostic marker in children with spondyloarthropathy, and correlation of HLA-B27 with radiological features and tuberculosis.

METHODS

Routine haematological and immunological tests were done by standard method and HLA-B27 typing was done by the lymphocytotoxicity method. A total of 70 cases of juvenile spondyloarthropathy were studied from May 2006 to September 2007. It included both males and females.

RESULTS

Positivity of HLA-B27 in childhood SSA was only 71.4 percent (50/70). Gender-wise analysis showed that 76.7 percent (46/60) males and 20.0 percent (2/10) of the female patients were HLA-B27 positive. In HLA-B27-positive cases, the sacroiliac, hip, ankle, lower spine and knee joints were more involved. Urinary tract infection, diarrhoea and constipation were more common in HLA-B27-positive cases. None of the HLA-B27 cases were positive for rheumatoid factor; however, C-reactive protein was raised in 60.5 percent. In bilateral/unilateral sacroiliitis diagnosed by radiographs, only 81.5 percent patients were HLA-B27 positive. Tuberculosis was diagnosed in 14.3 percent (10/70) of total cases in which HLA-B27 positivity was seen in 60 percent of cases (6/10).

CONCLUSION

Our study concludes that both HLA-B27 and radiological tests should be done in male children suspected to have SSA, because it can indicate early cases of juvenile spondyloarthropathy when radiological changes are not present, and it produces a more severe disease. HLA-B27 positivity probably also predisposes to tuberculosis.