BACKGROUND: Panel reactive antibody (PRA) test is important in that it could minimize the errorneous report of HLA crossmatch in emergent situation and be used as a information on nationwide organ sharing. However, only a few laboratories manage to do this test by home-ade tray. This study was intended to resolve the cause of discrepancy between EIA and AHG-DC which would be encountered when supplement AHG-DC was tested for EIA positive samples. METHODS: Reactivity of Lambda Antigen Tray class I and class II mixed (LAT-, One Lambda, CA, USA) was evaluated to 23 specimens which had been positive in AHG phase of HLA crossmatch. All the samples for PRA were tested by EIA screening kit primarily and then AHG-DC was applied only in EIA positive samples. Samples showing discrepant results between two tests were further evaluated by EIA identification panel, platelet absorption test, dithiothreitol (DTT) treatment, and HLA crossmatch (AHG-DC and flowcytometry) with lymphocytes having antigen specificity reactive to antibodies identified by EIA kit. RESULTS: Of 23 samples, 21 (91.3%) showed strong reactivity to EIA and remaining 2 were confirmed to have IgM type alloantibodies. Of 92 samples for PRA, 22 (23.9%) were positive in anti-LA class I. 10 of 22 samples with positive EIA showed negative results by AHG-DC. While three of them were identified of their antibody specificity, of which 2 samples confirmed to have CYNAP (cytotoxicity negative, adsorption positive) antibodies and one sample to be nonspecific reaction to class I antigens, remaining 7 samples were negative to all the wells of EIA identification (id.) kit. Signal/cut-ff (S/C) of all three samples reactive to EIA id. kit were more than 1.75. CONCLUSIONS: HLA antibody screening by EIA from transplant candidate is considered to be appropriate in that EIA could detect IgG anti-LA of all tested sera and CYNAP antibodies as well. It needs further study with larger number of samples whether S/C of EIA would be informative in cases showing EIA positive/ AHG-DC negative.
Absorption ; Adsorption ; Antibodies ; Antibody Specificity ; Blood Platelets ; Dithiothreitol ; Histocompatibility Antigens Class I ; Immunoenzyme Techniques* ; Immunoglobulin G ; Immunoglobulin M ; Isoantibodies ; Lymphocytes ; Mass Screening ; Sensitivity and Specificity

BACKGROUND: Panel reactive antibody (PRA) test is important in that it could minimize the errorneous report of HLA crossmatch in emergent situation and be used as a information on nationwide organ sharing. However, only a few laboratories manage to do this test by home-ade tray. This study was intended to resolve the cause of discrepancy between EIA and AHG-DC which would be encountered when supplement AHG-DC was tested for EIA positive samples. METHODS: Reactivity of Lambda Antigen Tray class I and class II mixed (LAT-, One Lambda, CA, USA) was evaluated to 23 specimens which had been positive in AHG phase of HLA crossmatch. All the samples for PRA were tested by EIA screening kit primarily and then AHG-DC was applied only in EIA positive samples. Samples showing discrepant results between two tests were further evaluated by EIA identification panel, platelet absorption test, dithiothreitol (DTT) treatment, and HLA crossmatch (AHG-DC and flowcytometry) with lymphocytes having antigen specificity reactive to antibodies identified by EIA kit. RESULTS: Of 23 samples, 21 (91.3%) showed strong reactivity to EIA and remaining 2 were confirmed to have IgM type alloantibodies. Of 92 samples for PRA, 22 (23.9%) were positive in anti-LA class I. 10 of 22 samples with positive EIA showed negative results by AHG-DC. While three of them were identified of their antibody specificity, of which 2 samples confirmed to have CYNAP (cytotoxicity negative, adsorption positive) antibodies and one sample to be nonspecific reaction to class I antigens, remaining 7 samples were negative to all the wells of EIA identification (id.) kit. Signal/cut-ff (S/C) of all three samples reactive to EIA id. kit were more than 1.75. CONCLUSIONS: HLA antibody screening by EIA from transplant candidate is considered to be appropriate in that EIA could detect IgG anti-LA of all tested sera and CYNAP antibodies as well. It needs further study with larger number of samples whether S/C of EIA would be informative in cases showing EIA positive/ AHG-DC negative.
Absorption ; Adsorption ; Antibodies ; Antibody Specificity ; Blood Platelets ; Dithiothreitol ; Histocompatibility Antigens Class I ; Immunoenzyme Techniques* ; Immunoglobulin G ; Immunoglobulin M ; Isoantibodies ; Lymphocytes ; Mass Screening ; Sensitivity and Specificity

Chronic kidney disease (CKD) is a worldwide problem. This study was designed to survey the prevalence and risk factors for CKD in Korea. The 2,356 subjects were selected in proportion to age, gender, and city. Subjects 35 yr of age or older were selected from 7 cities. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) Study equation, with albuminuria defined as a urine albumin to creatinine ratio of 30 mg/g or more. The overall prevalence of CKD was 13.7%. The prevalences of CKD according to stage were 2.0% stage 1, 6.7% stage 2, 4.8% stage 3, 0.2% stage 4, and 0.0% stage 5. The prevalences of microalbuminuria and macroalbuminuria were 8.6% and 1.6%, respectively. The prevalence of eGFR less than 60 mL/min/1.73 m2 was 5.0%. Age, body mass index (BMI), hypertension, diabetes mellitus, systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose were independent factors related to the presence of CKD. In conclusions, Korea, in which the prevalence of CKD is increasing, should prepare a policy for early detection and appropriate treatment of CKD. The present data will be helpful in taking those actions.
Adult ; Aged ; Albuminuria/diagnosis ; Diet ; Disease Susceptibility ; Female ; Glomerular Filtration Rate ; Humans ; Kidney Failure, Chronic/*epidemiology ; Korea ; Male ; Middle Aged ; Nephrology/methods ; Prevalence ; Risk Factors

Oxidative stress plays various roles in the development and progression of IgA nephropathy, while bilirubin is known as a potent antioxidant. We therefore hypothesized that serum bilirubin would be associated with renal prognosis in IgA nephropathy. The study subjects comprised 1,458 adult patients with primary IgA nephropathy in Korea. We grouped patients according to the following quartile levels of bilirubin: <0.4 mg/dL (Q1), 0.4-0.5 mg/dL (Q2), 0.6-0.7 mg/dL (Q3), and >0.8 mg/dL (Q4). The outcome data were obtained from the Korean Registry of end-stage renal disease (ESRD). Eighty patients (5.5%) contracted ESRD during a mean follow-up period of 44.9 months. The ESRD incidences were 10.7% in Q1, 8.2% in Q2, 2.8% in Q3, and 2.8% in Q4 (p<0.001). The relative risk of ESRD compared to that in Q1 was 0.307 (95% confidence interval [CI], 0.126-0.751) in Q3 and 0.315 (95% CI, 0.130-0.765) in Q4. The differences of ESRD incidence were greater in subgroups of males and of patients aged 35 yr or more, with serum albumin 4.0 g/dL or more, with normotension, with eGFR 60 mL/min/1.73 m2 or more, and with proteinuria less then 3+ by dipstick test. In conclusion, higher bilirubin level was negatively associated with ESRD incidence in IgA nephropathy.
Adult ; Bilirubin/*blood ; Disease Progression ; Female ; Glomerular Filtration Rate ; Glomerulonephritis, IGA/*blood/complications ; Humans ; Hypertension/complications ; Incidence ; Kidney Failure, Chronic/*blood/complications ; Male ; Middle Aged ; Risk ; Risk Factors ; Treatment Outcome