WALLACE V. EPSTEIN, M.D., F.A.C.P.; PAUL F. GULYASSY, M.D.; MARGARET TAN, M.S.; ANGUS I. RAE, M.B.
The free light (L) polypeptide chains of human immunoglobulins were measured in the serum and the urine of 14 uremic patients before bilateral nephrectomy, during an anephric period, and after 16 renal homotransplantation procedures. Markedly elevated serum and urine concentrations were found in all azotemic patients, and serum levels in general rose further after bilateral nephrectomy. Stable, elevated serum L-chain concentrations declined suddenly in two instances on institution of immunosuppressive therapy before homotransplantation. After successful homotransplantation serum levels became less than 0.02 mg/ml as L-chain diuresis occurred. Immediate failure of graft function was characterized by continued elevation of serum and urine concentrations of L chains in a pattern similar to the prenephrectomy stage. In the period from 7 to 25 days posttransplantation two groups of patients could be distinguished: those with elevated serum and urine L-chain concentrations and those who returned serum and urine L-chain concentrations to normal or near-normal. The first group was found to have a significantly higher prevalence of irreversible renal homograft rejections subsequently when compared to the second group. Homograft rejection was associated with a rise in the urine L-chain concentration. Successful treatment of a rejection episode was followed by the reverse series of events, with urine L-chain concentrations slowly returning to normal. Such measurements appear to provide an additional parameter of renal function and, as such, to serve as a prognostic and diagnostic guide in the course of renal homotransplantation.
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EPSTEIN WV, GULYASSY PF, TAN M, RAE AI. Effect of Renal Homotransplantation on the Metabolism of the Light Chains of Immunoglobulins. Ann Intern Med. 1968;68:48–62. doi: 10.7326/0003-4819-68-1-48
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Published: Ann Intern Med. 1968;68(1):48-62.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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