Endogenous urinary glucocorticoid metabolites and mortality in prednisolone-treated renal transplant recipients.

ABSTRACT: BACKGROUND:Chronic corticosteroid treatment suppresses HPA-axis activity and might alter activity of 11? hydroxysteroid dehydrogenases (11?-HSD). We aimed to investigate whether the endogenous glucocorticoid production and 11?-HSD activities are altered in prednisolone-treated renal transplant recipients (RTR) compared with healthy controls and whether this has implications for long-term survival in RTR. METHODS:In a longitudinal cohort of 693 stable RTR and 275 healthy controls, 24-hour urinary cortisol, cortisone, tetrahydrocorisol (THF), allotetrahydrocortisol (alloTHF), and tetrahydrocortisone (THE) were measured using liquid chromatography tandem-mass spectrometry. Twenty-four-hour urinary excretion of cortisol and metabolites were used as measures of endogenous glucocorticoid production; (THF + alloTHF)/THE and cortisol/cortisone ratios were used as measures of 11?-HSD activity. RESULTS:Urinary cortisol and metabolite excretion were significantly lower in RTR compared with healthy controls (P < .001), whereas (THF + alloTHF)/THE and cortisol/cortisone ratios were significantly higher (P < .001 and P = .002). Lower total urinary metabolite excretion and higher urinary (THF + alloTHF)/THE ratios were associated with increased risk of mortality, independent of age, sex, estimated glomerular filtration rate, C-reactive protein, body surface area, and daily prednisolone dose, respectively. CONCLUSIONS:Endogenous glucocorticoid production and 11?-HSD activities are altered in prednisolone-treated RTR. Decreased total urinary endogenous glucocorticoid metabolite excretion and increased urinary (THF + alloTHF)/THE ratios are associated with increased risk of mortality.

SUBMITTER: Vulto A 

PROVIDER: S-EPMC7216873 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature