ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on Twitter

Kidney Week

Abstract: TH-PO1102

A Urinary Metabolite Constellation to Detect Acute Rejection in Kidney Allografts

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical


  • Banas, Miriam C., University of Regensburg - Nephrology, Regensburg, Germany
  • Neumann, Sindy, numares AG, Regensburg, Germany
  • Schiffer, Eric, numares AG, Regensburg, Germany
  • Bohmig, Georg, Medical University Vienna, Vienna, Austria
  • Pagel, Philipp, numares AG, Regensburg, Germany
  • Schäffler, Katharina, University of Regensburg - Nephrology, Regensburg, Germany
  • Krämer, Bernhard K., University Hosptal Mannheim, Mannheim, Germany
  • Banas, Bernhard, University of Regensburg - Nephrology, Regensburg, Germany

Post-transplant surveillance for acute rejection is mainly based on regular monitoring of serum creatinine levels and transplant biopsies upon functional renal impairment. Recently, we developed a novel method to detect kidney allograft rejection via a characteristic constellation of the urine metabolites alanine, citrate, lactate, and urea investigated by nuclear magnetic resonance (NMR) spectroscopy (Banas M et al., Metabolomics 2018).


Within the prospective, observational UMBRELLA study 986 urine specimens were collected from 109 consecutively enrolled renal transplant recipients and metabolite constellations were analyzed by NMR spectroscopy. A metabolite rejection score was calculated and compared to histopathological results of corresponding allograft biopsies (n=206).


The metabolite constellation was found to be a useful biomarker to non-invasively detect acute allograft rejection (AUC = 0.75; 95% confidence interval (CI) 0.68 to 0.83; based on 46 cases with biopsy-proven rejection and 520 controls). A combination of the metabolite rejection score and the estimated glomerular filtration rate (eGFR) at the time of urine sampling further improved the overall test performance significantly (AUC = 0.84; 95% CI 0.76 to 0.91; based on 42 cases and 468 controls). In a subgroup of patients without rejection episodes the test results remained well below a diagnostic threshold associated with high risk of acute rejection. In other cases a marked increase above this threshold indicated an acute allograft rejection already 6-10 days before diagnostic renal biopsies were performed.


In conclusion, a combination of an NMR-based urine metabolite analysis and glomerular filtration rate is promising as a non-invasive test for post-transplant surveillance and to support decision making whether renal allografts need histopathological evaluation.


  • Commercial Support