NEPHROLOGY - ORIGINAL PAPER CRP and acute renal rejection: a marker to the point Amin Roshdy • Mohamed M. El-Khatib • Mary N. Rizk • Amal M. El-shehaby Received: 12 August 2011 / Accepted: 21 November 2011 / Published online: 3 January 2012 Ó Springer Science+Business Media, B.V. 2011 Abstract Objectives C-reactive protein (CRP) is increased in end-stage renal disease patients. Recent studies have shown positive associations between inflammatory markers and cardiovascular mortality in kidney trans- plant recipients. The aim of the present study was to examine the correlation between CRP and early detection of renal allograft rejection. Furthermore, investigate the association between pretransplant levels of CRP with the development of acute renal allograft rejection as a possible predictive marker. Methods Ninety-one renal transplant recipients were sequentially analyzed. The median follow up of patients was 8 weeks. Basal and 8 weeks post transplant CRP levels were assessed. Results CRP levels were significantly higher in allograft rejection both in the pretransplant (n = 25, P = 0.001) and postransplant (n = 33, P = 0.001) phases when compared to those without rejection. By stepwise multiple regression analysis, rejection in transplanted patients was independently correlated to albumin/creatinine ratio and CRP 8 weeks after transplantation. Conclusion Elevated pretransplant serum CRP level is a risk predictor for acute rejection episodes and may be a useful predictive marker in the follow-up of post- transplantation patients. Keywords Renal transplant Á CRP Á Acute rejection Á Inflammation Introduction Acute renal allograft rejection is one of the main concerns in modern transplantation era, with an incidence of 10% of the cases [1]. The lack of non- invasive biomarkers of rejection makes it difficult to optimize anti-rejection therapy for transplant recipi- ents. A challenging task is balancing the need for immunosuppression to prevent allograft rejection while minimizing drug toxicity and the risk of infections and malignancy. At the present time, renal allograft biopsy with conventional histological examination remains the gold standard for diagnosis of acute rejection among transplant patients with deterioration in kidney function. Yet, this is invasive, carries some hazards and is, to say the least inconvenient. Some additional clinical manifestations include decreased urine output, increased blood pressure, pyuria, and/or new or worsening proteinuria. Most rejection patients are also asymptomatic, with fever and local graft pain and A. Roshdy Á M. M. El-Khatib Á M. N. Rizk Internal Medicine Department, Faculty of Medicine, Cairo University, Giza, Egypt A. M. El-shehaby (&) Medical Biochemistry Department, Faculty of Medicine, Cairo University, Giza, Egypt e-mail: amrsh2006@yahoo.com 123 Int Urol Nephrol (2012) 44:1251–1255 DOI 10.1007/s11255-011-0098-4