Non-invasive detection of acute renal allograft rejection by measurement of vascular endothelial growth factor in urine

Urinary vascular endothelial growth factor (VEGF) was determined by enzyme-linked immunosorbent assay in 199 renal allograft recipients and 80 healthy controls. Urinary VEGF level did not change significantly during the first 8 weeks after transplantation in 119 patients with stable renal function and there were no abnormal histological findings (No-AR). In 67 patients with acute rejection, urinary VEGF was significantly higher (28.57 +/- 6.21 pg/mu mol creatinine) than in the No-AR patients (3.05 +/- 0.45 pg/mu mol creatinine) and healthy controls (2.87 +/- 0.35 pg/mu mol creatinine). At a cut-off point of 3.26 pg/mu mol creatinine, sensitivity and specificity for diagnosis of acute rejection were 86.6 and 71.4%, respectively. The 13 patients with subclinical rejection excreted urinary VEGF (16.14 +/- 4.09 pg/mu mol creatinine) at a significantly higher level than No-AR patients (3.05 +/- 0.45 pg/mu mol creatinine). At a cut-off point of 4.69 pg/mu mol creatinine, sensitivity and specificity for diagnosis of subclinical rejection were 84.6 and 79.8%, respectively. In conclusion, monitoring VEGF in urine might offer a new non-invasive way to detect acute and subclinical rejection in renal transplant recipients.