A recent article in NEJM discusses using an urine test to detect pre rejection the risk of rejection in a kidney transplant recipient. In a multicenter study, a molecular signature of CD3ε mRNA, IP-10 mRNA, and 18S rRNA levels in urinary cells appears to be diagnostic and prognostic of acute cellular rejection in kidney allografts.
An editorial accompanies it calls this test the " rejectostix". The lead author Dr. Suthanthiran discusses this idea and test on a youtube exclusive interview as well. The team measured the levels of messenger RNA (mRNA) molecules produced as genes are being expressed, or activated, to make proteins. The mRNAs (18S ribosomal (rRNA)–normalized CD3ε mRNA, 18S rRNA–normalized interferon-inducible protein 10 (IP-10) mRNA, and 18S rRNA) indicate that killer T immune cells are being recruited to the kidney in order to destroy what the body has come to recognize as alien tissue. The signature test consists of adding levels of the three mRNAs in urine into a composite score. This would be a nice detective tool for the transplant nephrologist. Check out an exclusive interview of the researchers from Cornell.
Is this our future? hope so, if this holds:- no more kidney biopsies. If you know it early on, you can address it sooner... hope to see this in clinical practice.
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