Уровень базального триптаза растет при прогрессировании хронической болезни почек

Serum baseline tryptase (sBT) levels can rise significantly as chronic kidney disease (CKD) advances, a finding investigators say should prompt caution before performing an extensive workup for systemic mastocytosis (SM) or hereditary alpha tryptasemia (HAT) in patients with declining kidney function, according to findings published in the Journal of Allergy and Clinical Immunology: Global. Results of a retrospective study from the Mayo Clinic Enterprise found median sBT levels increased with CKD stage, from 4.2 ng/mL in stage 1 to 5.1 ng/mL in stage 2, 6.7 ng/mL in stage 3, 10.7 ng/mL in stage 4, and 6.8 ng/mL in stage 5, 5 of 6 of whom were undergoing hemodialysis. The investigators reviewed records of 120 outpatient nephrology patients treated across the Mayo Clinic Enterprise between January 2020 and July 2025 who had a confirmed CKD diagnosis and an sBT measurement obtained within 40 days of an estimated glomerular filtration rate (eGFR) test. CKD stage was defined by eGFR, and patients with conditions known to independently elevate tryptase, including systemic mastocytosis, HAT, and renal transplant, were excluded. Linear regression confirmed a statistically significant association between advancing CKD stage and higher sBT (P =0.001), and the association held when the Kruskal-Wallis test was applied without the linear assumption (P =0.002). The finding echoes a Spanish cohort study that found significantly higher tryptase levels in patients with stage 4 and 5 CKD and those on hemodialysis compared with patients with stage 1 and 2 disease (P <0.01). “By incorporating renal function into tryptase interpretation, unnecessary diagnostic evaluations for conditions like systemic mastocytosis or hereditary alpha tryptasemia may be avoided in patients with chronic kidney disease,” the authors wrote. The authors noted several limitations, including small sample sizes in CKD stages 1 and 5, potential referral bias associated with a tertiary care setting, and the retrospective design. They called for larger, multi-institution cohorts to establish CKD-specific tryptase reference ranges or develop eGFR-based adjustment models, along with prospective studies to clarify the relationship between renal function and sBT. The authors advised clinicians evaluating elevated tryptase in patients with reduced kidney function to consider obtaining a concurrent eGFR and weigh renal impairment as a possible explanation before initiating a mast cell disorder evaluation. This article originally appeared on Rare Disease Advisor References: Gansert E, Estrada-Mendizabal RJ, Voelker DH, et al. Serum baseline tryptase levels across chronic kidney disease stages: a retrospective report. J Allergy Clin Immunol Global. Published online August 14, 2026. doi:10.1016/j.jacig.2026.100777