THE SIGNIFICANCE OF URINARY IONIZED CALCIUM AS THE EARLY DIAGNOSIS OF ACUTE REJECTION IN A CASE OF RENAL TRANSPLANTATION

Abstract

The estimation of various urinary excretes has been reported valuable in the diagnosis of acute rejection of renal transplantation. They include protein, Na/K ratio, the WBC count, γ-GTP, LAP, and β₂-microglobulin. This paper reports the significance of urinary ionized calcium as the diagnostic tool of acute rejection among various urinary parameters in a 19 year-old female undergoing renal transplantation. In this case, the change of urinary protein, β₂-microglobulin and LAP appeared later than clinical diagnosis of acute rejection. On the other hand, urinary ionized calcium was changed simultaneously with urinary Na/K ratio and γ-GTP at the onset of acute rejection. The decrease of urinary ionized calcium was more prominent than that of urinary Na/K ratio.
The estimation of urinary ionized calcium can be easily performed at the bedside by the Orion calcium analyser. It was valuable in the early diagnosis of acute rejection in our case.
Decreased urinary ionized calcium is assumed to reflect lowered RBF, GFR and tubular function of grafted kidney suffering acute rejection.