Presented October 25th - 28th, 2007 at the 2007 Urological Research Society (URS) Meeting - Napa, California

Objective: C-reactive protein (CRP) is an acute phase protein that is predominantly produced by hepatic cells. The main stimulus for CRP production by hepatic cells is an acute inflammation. The most important role of CRP is its interaction with the complement system, which is one of the body's immunologic defense mechanisms. In this paper, we describe the role of CRP in inflammatory and malignant urologic disease. Also, CRP was correlated to different surgical approaches to determine their invasiveness.

Methods: Circulating CRP can be measured in serum and plasma. CRP expression is determined by PCR or immunohistochemistry. We analyzed circulating CRP in patients with an acute scrotum to discriminate between testicular torsion and acute epididymitis. Additionally, in patients who underwent different laparoscopic procedures and open surgical procedures CRP in serum were measured before, during and after the procedures. Also, circulating CRP was also determined in patients with renal cell carcinoma (RCC). We additionally analyzed intrarenal and intratumoral CRP expression by means of quantitative real-time PCR and immunohistochemistry.

Results: CRP levels were elevated in almost all patients with epididymitis but not in those with testicular torsion. The marker provided the best discrimination between both conditions. Also, CRP showed different results when comparing surgical approaches. For instance, the increase of CRP was twice as high after open unilateral nephrectomy compared to the laparoscopic approach. There were no differences for smaller operative procedures. In malignant disease CRP correlated to disease burden. In patients with RCC, preoperative plasma CRP levels correlated with tumor stage and grade. CRP mRNA expression was detected in 80% of samples from tumor center, tumor margin, and unaffected surrounding renal tissue, respectively. Immunohistochemically, a strong CRP production was observed both in tumor cells and in tubular epithelial cells in unaffected tissue, respectively.

Conclusions: We could demonstrate that CRP is an important marker in inflammatory disease (e.g. epididymitis) but also in malignant disease (e.g. RCC) and when describing the invasiveness of an operative trauma (e.g. laparoscopic versus open operative approach). Furthermore, CRP is not just only produced by hepatic cells but also by renal tubular as well as renal tumor cells.

Authors: Doehn C

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