99Tcm-DTPA肾动态显像评估活体供肾功能

目的 分析99Tcm-DTPA肾动态显像法在亲属活体肾移植供肾功能评价中的应用和影响因素,探讨其临床应用价值和判定标准. 方法对亲属活体肾移植供体在术前应用99Tcm-DTPA肾动态显像法测定双侧肾脏肾小球滤过率(GFR)和尿肌酐法计算24 h内生肌酐清除率(CCr)评估肾功能.手术前、后对2种方法的检测结果进行对比.对留存肾进行手术前、后的比较,观察其代偿性变化.结果 供者术前SCr为(79.87±17.63)μmol/L,术后为(99.93±20.63)μmol/L,与术前比较,升高25.12%(P=0.000),但仍在正常范围.术前CCr为(1.56±0.29)ml/s,术后为(1.07±0.29)ml/s,较术前降低31.41%(P=0.019).术前供者双肾GFR为(72.32±18.70)ml/min,较CCr低22.95%.术后留存肾GFR为(54.39±15.63)ml/min,较术前[(36.64±9.15)ml/min]增加48.44%(P=0.000),但与术前双肾GFR比较则下降24.79%(P=0.021).手术前后比较差异均有统计学意义(P值均＜0.05).术前BUN为(5.39±1.43)mmol/L,术后为(5.84±1.29)mmol/L,升高8.35%(P=0.076).结论 99Tcm-DTPA肾动态显像法测定GFR是观察肾功能比较灵敏的指标,能直观评估分肾的肾小球滤过功能,评估尿路排泄情况,并可以动态观察留存肾功能的代偿性变化.     

老年活体亲属供肾移植的安全性分析

目的 探讨老年活体亲属供肾移植供体、受体的围手术期并发症、疗效及安全性.方法 亲属活体供肾移植132例,分为老年供体组(≥55岁,43例)和中青年供体组(＜55岁,89例);对供受体的住院时间、手术前后血肌酐(SCr)、内生肌酐清除率(CCr)、肾小球滤过率(GFR)、并发症以及受体的急性排斥反应率、人/肾存活率等进行比较分析.结果 2组供者术前SCr分别为(77.67±15.21)、(83.09±15.98)μmol/L,术后7 d分别为(109.54±22.32)、(106.56±23.46)μmol/L,均在正常范围内,2组间各时间点比较差异均无统计学意义(P值均＞0.05).术后3个月2组供者SCr分别为(112.57±20.87)、(104.29±19.43)μmol/L,与术前比较分别上升44.93%和25.51%,老年供体组比中青年供体组供者scr升高更明显.差异有统计学意义(P=0.0268).2组术前CCr分别为(1.63±0.34)、(1.56±0.25)ml/s,术后10 d分别为(0.83±0.29)、(1.11±0.27)ml/s.老年供体组术后3个月CCr为(0.97±0.10)ml/s,中青年供体组为(1.16±0.17)ml/s.2组手术前后CCr变化差异无统计学意义(P＞0.05).老年供体组术后10 d的留存肾GFR为(36.58±13.26)ml/min,术后3个月增加至(52.31±12.74)ml/min,达到原双肾GFR[(73.01±20.96)ml/min]的71.65%.中青年供体组术后10 d GFR为(38.32±10.79)ml/min,术后3个月增至(56.31±12.95)m1/min,达到原双肾GFR[(78.34±20.98)ml/min]的71.88%.手术前后GFR变化差异均无统计学意义,P值均＞0.05.供者手术并发症包括术中脾脏包膜下血肿1例、降结肠破裂1例和切口脂肪液化5例.术前和术后各时间点2组受者SCr水平差异无统计学意义(P值均＞0.05).2组供者平均住院时间分别为(13.2±3.4)和(12.8±2.6)d,P=0.4563.2组受者平均住院时间分别为(23.1±11.9)和(22.3士11.4)d,P=0.6991.老年供体组受者6个月内急性排斥反应发生率为4.7%(2/43),中青年供体组为7.9%(7/89).术后1年内2组各死亡1例,中青年供体组因急性排斥反应移植肾失功1例.结论 老年活体亲属供肾可能存在一定危险性,应予以重视,但供体年龄并非独立风险因素.在严格控制老年供者的纳入标准、对供者进行全面系统评估的情况下,老年供体活体肾移植的供体和受体围手术期并发症/疗效及安全性与中青年供体比较无明显差异.     

亲属活体肾移植供者的安全性分析

目的 分析亲属活体肾移植供者手术前后的相关指标变化,探讨活体供者的安全性.方法对132例亲属活体供肾者进行心理和生理分析,包括尿常规、血生化、肾小球滤过率(GFR)、内生肌酐清除率(CCr)和生活质量等指标.结果 132例供肾者的生活质量评分与正常人群比较差异无统计学意义(P＞0.05).供肾切取术前供者血肌酐(SCr)为(78.33±15.94)μmol/L,术后7 d为(108.49±19.88)μmol/L(P=0.000);术后6个月为(112.47±20.38)μmol/L,与术后7 d比较差异无统计学意义(P=0.109).供肾切取术前供者CCr为(95.80±20.92)ml/min,术后7 d为(57.36±14.92)ml/min,与术前比较P=0.017;术后6个月为(65.49±8.25)ml/min,与术后7 d比较差异无统计学意义(P=0.619).术前双肾GFR为(74.08±18.51)ml/min,右肾GFR为(38.43±10.33)ml/min,供肾切取术后6个月保留右肾GFR为(56.49±13.01)ml/min,与术前双肾GFR比较,P=0.000;保留右肾GFR与术前自身比较代偿性增加47.0%.手术并发症包括脾脏包膜下出血1例,降结肠破裂1例,切口脂肪液化5例. 结论 术前对供肾者进行充分系统的医学心理学和生理学评估,严格履行风险告知义务,供受者术中规范操作,围手术期合理管理和建立严密的随访制度,可以有效提高亲属活体移植供肾者的心理和生理安全性.     

老年活体供肾移植术后供者安全性及受者移植效果的分析

目的 分析老年活体供肾移植术后供者的安全性及受者的移植效果.方法 回顾性分析251例亲属活体供肾移植的临床资料.根据供者年龄,将251例活体供肾移植分为老年供肾组(≥55岁)和中青年供肾组(<55岁),对手术前后两组供、受者的血清肌酐(Cr)、肾小球滤过率(GFR)、内生肌酐清除率(Ccr)、并发症、平均住院时间以及受者的人/肾存活率、急性排斥反应发生率进行比较和分析.结果 老年供肾组和中青年供肾组供者手术前后血Cr水平的差异无统计学意义(P>0.05),而Ccr的差异有统计学意义(P<0.05).老年供肾组与中青年供肾组供者比较,术前总GFR、留存肾GFR及术后10 d留存肾GFR比较,差异均无统计学意义(P>0.05);老年供肾组供者术后10 d与术前的留存肾GFR比较,差异无统计学意义(P>0.05);中青年供肾组供者术后10 d的留存肾GFR较术前明显上升,差异有统计学意义(P<0.05).老年供肾组与中青年供肾组受者比较,手术前后各相应时间点的血Cr水平差异无统计学意义(P>0.05).老年供肾组和中青年供肾组供者平均住院时间分别为(16.67±7.78)d和(16.11±5.89)d(P>0.05),受者平均住院时间分别为(29.61±24.28)d和(28.76±19.27)d(P>0.05).两组受者6个月内急性排斥反应发生率分别为6.50%和5.75%(P>0.05).老年供肾组受者术后死亡1例,中青年供肾组死亡3例,并有1例因急性排斥反应切除移植肾.结论 老年活体供肾移植术前应对供者进行严格的选择,在进行全面系统评估的前提下,可以保证供者术后的安全以及受者的移植效果.     

保留肾单位术与根治性肾切除术对肾功能影响的比较

目的比较保留肾单位手术和根治性肾切除手术治疗早期局限性肾癌术后肾功能的变化,同时探讨不同的肾功能指标在临床中的指导作用。方法回顾性分析了南京鼓楼医院2013年6月至2014年10月期间63例早期肾肿瘤患者的临床资料和术后随访资料。35例患者接受保留肾单位术(保肾组),28例患者行根治性肾切除术(根治组),所有的患者均随访满两年,随访期间患者的血肌酐、尿酸、估算肾小球滤过率、胱抑素C、尿微量白蛋白及尿β2微球蛋白被搜集并记录下来。结果 63例患者术后肾功能均有不同程度的变化,术后早期肾功能的损伤表现更为明显。随着随访时间的延长,大部分患者肾功能可逐渐恢复。保肾组术后急性肾功能不全的发生率为34%,根治组急性肾功能不全的发生率为79%,两组差异具有统计学意义(P0.01)。术后总体随访结果显示估测肾小球滤过率、胱抑素C及β2微球蛋白变化差异具有统计学意义(P0.05),而血肌酐、尿酸及尿微量白蛋白差异无统计学意义。虽然两组的尿酸及微量白蛋白水平差异无统计学意义,但保肾组的平均水平低于根治组。在术后肾功能异常的早期检测方面,各指标的独立检测阳性率均较低,尤其是血肌酐、尿酸及估测肾小球滤过率等传统肾功能指标。当各指标互相联合后,肾功能异常的检测阳性率明显提高,保肾组及根治组的联合检测阳性率分别达37.1%和71.4%。结论在早期局限性肾肿瘤的治疗中,保留肾单位手术较根治性手术对患者肾功能的损伤更小。胱抑素C、尿微量白蛋白、尿β2微球蛋白对于发现术后肾功能的早期异常更敏感,可与肌酐、尿酸、估测肾小球滤过率起协同作用。     

活体肾移植供肾肾小球滤过率对受体早期肾功能的影响

目的 探讨活体肾移植供肾肾小球滤过率( GFR)对受体早期肾功能的影响.方法 2006年至2011年在本中心接受活体肾移植172例为研究对象,其中亲属供肾166例(96.5％),夫妻供肾5例(2.9％),帮扶供肾1例(0.6％).术前应用放射性核素99mTC-DTPA肾动态显像测定供体左右肾GFR.供体的双肾GFR为62～148 ml/min,将对象分为供肾GFR≤45ml/min受体76例和供肾GFR＞45 ml/min 96例.两组受体的透析情况、冷、热缺血时间、抗体诱导及免疫抑制方案、HLA错配率等基本资料相似.评价患者术后早期肾功能变化情况.结果 两组患者术后急性排斥反应以及肾功能延迟恢复( DGF)发生率差异无统计学意义.与供肾GFR≤45 ml/min组比较,供肾GFR＞45 ml/min组的Scr在术后1周、1个月、3个月、1年均较低,其中术后1周的差异有统计学意义(P＜0.05);术后1个月、3个月、1年的差异均无统计学意义.重复测量的方差分析显示术后1年内两组受体Scr变化差异无统计学意义.结论 活体肾移植供肾GFR高低对受体术后1周Scr下降水平有影响,供肾GFR高者受体术后1周Scr水平低,但是对受体术后早期(1年内)的Scr整体水平及变化趋势无显著影响.     

腹腔镜保留肾单位肾部分切除术后肾功能分析

目的 寻求影响腹腔镜下保留肾单位肾部分切除术(LNSS)后肾功能恢复的主要因素,检测LNSS的安全性,明确肾脏热缺血安全时间.方法 回顾性分析本院30例次LNSS患者的临床资料,术前及术后3个月采用99Tcm-二乙三胺五乙酸肾动态显象检测肾小球滤过率(GFR),术前、术后24h及术后一周检测血肌酐水平,统计分析影响术后...     

超选择性肾分支动脉栓塞联合零缺血后LPN对T1期肾癌患者术后肾功能影响

目的探讨数字减影技术(DSA)超选择性肾分支动脉栓塞联合零缺血后腹腔镜肾部分切除术(LPN)治疗T1期肾癌的安全性及对患者肾功能的影响。方法选择2017年5月至2020年4月在本院因T1期肾癌行后LPN的39例患者, 术前1～12 h先在介入手术室行DSA超选择性肾肿瘤靶动脉栓塞, 然后再行后腹腔镜下零缺血肾部分切除术。对患者的手术时间、术中出血量、术后胃肠道功能恢复所需时间、术后住院时间等进行分析, 比较术前24 h和术后24 h、7 d、30 d的血尿素氮(BUN)、血肌酐(Scr)水平, 同时对患者术前及术后6个月的分肾小球滤过率(GFR)结果进行分析。结果所有手术均成功完成。患者手术时间为(123.2±7.6) min, 术中出血量为(108.5±66.3)mL, 术后胃肠道功能恢复时间为(2.5±0.6)d, 术后住院时间为(7.6±1.5)d。术前及术后的Scr、BUN水平比较, 差异均无统计学意义(均P>0.05);术后6个月患肾的GFR为(45.6±8.4)mL/min, 较术前的(59.0±9.5)mL/min降低(P<0.001), 而健侧肾的术后GFR...     

保留肾单位手术后肾功能预后的影响因素分析

目的:探讨肾肿瘤行保留肾单位手术(NSS)后肾功能预后的影响因素。方法:回顾性分析西京医院2016年12月至2018年12月行NSS治疗的115例肾肿瘤患者的临床资料。男75例,女40例。年龄(49.50±12.94)岁;体质指数(24.59±3.59)kg/m 2;肿瘤最大径(3.66±1.32)cm;R.E.N.A.L.评分(6.43±1.60)分。术前患肾肾小球滤过率(GFR)(48.22±11.48)ml/(min·1.73m 2),健肾GFR(49.73±11.96)ml/(min·1.73m 2),总GFR(97.95±21.32)ml/(min·1.73m 2)。术前患肾有功能肾组织体积(FPV)(132.23±9.11)cm 3。61例行腹腔镜肾部分切除术,54例行机器人辅助腹腔镜肾部分切除术。记录手术时间、热缺血时间(WIT)、术后病理结果。记录术后6个月的血肌酐、患肾GFR、健肾GFR、总GFR、GFR保存率(术后GFR与术前GFR的比值)、患肾FPV、患肾FPV保存率(术后患肾FPV与术前FPV的比值)。患肾FPV通过手术前后的CT影像使用椭球体近似法测量。手术前后GFR和患肾FPV比较采用配对样本t检验。采用Spearman秩相关分析评估各研究因素与患肾GFR保存率间的相关性。多因素分析采用多元线性回归模型分析患肾功能的独立预测因素。以WIT=25 min为截断点将患者分为≤25 min组和>25 min组,比较两组术前患肾GFR,以及术后6个月的患肾GFR和患肾GFR保存率。结果:本组115例手术均顺利完成,中位手术时间135(75~245)min,WIT(24.57±5.51)min。患肾术后GFR(35.50±7.81)ml/(min·1.73 m 2),与术前比较差异有统计学意义(P<0.001),患肾GFR保存率为(74.65±11.10)%。术后6个月患肾FPV保存率为(84.28±4.37)%,与术前比较明显减少(P<0.001)。患肾FPV保存率与患肾GFR保存率呈极强正相关(r=0.802);WIT与患肾GFR保存率呈中等程度负相关(r=-0.503)。多元线性回归分析结果显示,术前患肾GFR(b=-0.150,P=0.008)、WIT(b=-0.443,P<0.001)、患肾FPV保存率(b=1.638,P<0.001)是患肾GFR保存率的独立预测因素。WIT>25 min组和≤25 min组的患肾GFR保存率分别为(68.77±10.88)%和(79.34±8.88)%,差异有统计学意义(P<0.001)。结论:在WIT较短(<30 min)的情况下,正常肾组织数量的保留是影响NSS术后肾功能预后的重要因素,有限的WIT起次要作用。在保证肿瘤完整切除的前提下,应尽可能保留更多的正常肾组织,同时尽量将WIT控制在25 min以内。     

70岁以上老年供肾活体肾移植18例疗效分析

目的探讨70岁以上老年供肾活体肾移植的临床疗效。方法以2017年9月至2019年6月中国科技大学附属第一医院(安徽省立医院)肾移植科18例供者年龄超过70岁的活体肾移植供、受者为研究对象, 收集围手术期临床资料和随访数据, 根据单侧供肾肾小球滤过率(GFR)是否低于40 ml/(min·1.73 m2)分为低供肾GFR组(8例)和正常供肾GFR组(10例), 分别对两组血肌酐和移植肾存活率等参数进行统计学分析。同时回顾性分析术后并发症等随访结果。结果 18例供、受者均手术顺利, 未发生严重围手术期并发症和二次手术;受者术后未发生移植物功能延迟, 围手术期出现急性排斥反应1例(5.6%), 术后第3天平均血肌酐(155.7±63.5)μmol/L, 出院时血肌酐(97.6±28.7)μmol/L;随访时间37.5个月(27～48个月), 18例供者术后恢复顺利, 随访期间健康状况良好, 未发生蛋白尿、供肾手术相关住院或死亡, 出院血肌酐(86.8±18.3)μmol/L, 末次随访血肌酐(84.4±15.0)μmol/L, 两组差异无统计学意义(P=0.610);18例受者随访期间受者、...     

Effect of gender matching on the outcomes of living-donor renal transplantation

Objective To evaluate the effect of gender matching on the outcomes of living-donor renal transplantation. Methods A total of 419 cases of living-donor renal transplantation in our center were divided into male-donor-male-recipient (MDMR) group, male-donor-female-recipient (MDFR) group, female-donor-male-recipient (FDMR) group, female-donor-female-recipient (FDFR) group. The outcomes including graft and patient survival, acute rejection and renal function were analyzed retrospectively. Results Compared to MDMR group, MDFR group and FDFR group had lower Scr [(80.7±17.9), (87.4±21.9) μmol/L vs (120.3±72.5) μmol/L, all P＜0.05] and uric acid (UA) [(318.1±86.4), (303.5±66.9) μmol/L vs (358.4±77.8) μmol/L, P＜0.05] 6 months after operation. Compared to MDFR group, FDMR group had higher Scr[(117.7±27.4) μmol/L vs (80.7±17.9) μmol/L, P＜0.01], UA [(371.0±92.4) μmol/L vs (318.1±86.4) μmol/L, P＜0.05] and lower glomerular filtration rate (GFR) [(70.4±17.8) ml/min vs (79.6±18.9) ml/min, P＜0.05]. Compared to FDMR group, FDFR group had lower Scr [(87.4±21.9) μmol/L vs (117.7±27.4) μmol/L, P＜0.01] and UA [(303.5±66.9) μmol/L vs (371.0±92.4) μmol/L, P＜0.01]. Compared to MDFR group, FDFR group showed lower GFR [(72.4±25.3) ml/min vs (82.7±18.7) ml/min, P＜0.05] 1 year after operation. Compared to MDMR group, FDFR group showed lower UA [(322.9±69.7) μmol/L vs (376.0±66.2) μmol/L, P＜0.05] 2 years after operation. Compared to FDMR group, FDFR group showed lower Scr [(88.7±27.0) μmol/L vs (112.7±27.8) μmol/L, P＜0.05] and UA [(318.3±61.2) μmol/L vs (396.2±100.3) μmol/L, P＜0.05] 3 years after operation. 5 years after operation, there were no significant differences in above indexes, the incidence of slow graft function, acute rejection and survival of graft and patient among groups. Conclusions Male recipients of female donors have the worst renal function while female recipients have better outcomes after operation.     

Protective effect of resveratrol on 5/6 nephrectomized rats and its mechanism

Objective To investigate the protective effect of resveratrol (RSV) on 5/6 nephrectomized rats and its mechanism. Methods Fifty male SD rats were randomly divided into three groups: sham operated (Sham, n＝10）, 5/6 nephrectomy (Nx, n＝20), and 5/6 nephrectomy＋RSV 20 mg/kg (Nx＋RSV, n＝20). RSV or normal saline was administered one week after 5/6 nephrectomy. Proteinuria was detected every 4 weeks. Serum creatinine and the renal pathological changes were measured after 12 weeks. Immunohistochemisty staining of fibronectin (FN), collagenⅠ, transforming growth factor-β (TGF-β) and connective tissue growth factor (CTGF) were used to analyze the changes of renal fibrosis. Western blotting was used to measure the expression of Smad3, phospho-Smad3, and acety-Smad3. Immunoprecipitation was used to detect the interaction between Sirt1 and Smad3. Results Compared with the sham operated rats, subtotal nephrectomy significantly increased proteinuria [(152.14±30.49) mg/24 h vs (25.34±7.54) mg/24 h], serum creatinine[(111.60±21.50) μmol/L vs (53.90±11.59) μmol/L], glomerular sclerosis index (1.56±0.34 vs 0.35±0.08) and the expressions of fibronectin, collagenⅠ, TGF-β and CTGF in renal tissue at 12 weeks after operation (all P＜0.01), and RSV treatment significantly inhibited the above up-regulations (all P＜0.01). Compared with the sham operated rats, subtotal nephrectomy increased the expression of phospholylation and acetylation of Smad3. RSV treatment significantly reduced the expression of acety-Smad3, but had no effect on the phospho-Smad3. Immunoprecipitation revealed a binding effect of Smad3 with Sirt1. Conclusions RSV treatment can attenuate proteinuria, protect renal function and inhibit renal fibrosis in 5/6 nephrectomized rats. This renal protective effect is associated with reduced Smad3 acetylation and activation of Sirt1, which suggesting that Sirt1 may be a potential therapeutic target of CKD.     

The mechanism of focal necrotizing glomerulonephritis induced by FimH fusion protein

Objective To investigate the mechanism of focal necrotizing glomerulonephritis induced by FimH fusion protein. Methods Wistar-Kyoto (WKY) rats were immunized with purified FimH fusion protein (150 μg) emulsified in Titermax Gold. Controls received PBS in Titermax Gold alone. Glomerular injuries were assessed by 24-hour urinary protein, urea nitrogen (BUN), serum creatinine (Scr), serum uric acid (UA) and histomorphology. The levels of interleukin-17A (IL-17A) were detected by ELISA assay. Results The levels of 24-hour urinary protein began to rise at 3rd day after immunization with FimH fusion protein, and were significantly higher than control group on 7th , 35th and 50th day [(8.59±1.25) mg vs (3.08±1.08) mg, (10.33±1.10) mg vs (6.40±0.61) mg, (12.45±1.73) mg vs (5.93±0.83) mg, all P＜0.05].The serum levels of BUN, Scr, UA in model rats were increased significantly at 50th day [(6.76±0.20) mmol/L vs (5.82±0.13) mmol/L, (58.00±1.53) μmol/L vs (25.67±1.45) μmol/L,(61.67±7.27) μmol/L vs (31.33±2.73) μmol/L, all P＜0.05] compared to control group. WKY rats immunized with FimH fusion protein showed segmental necrosis of glomerular capillaries, alveolar wall thickening, and significant inflammatory cells infiltration on 35 th day, and glomerular crescent formation after 50 days. The serum levels of IL-17A were increased significantly compared to control group on 35th and 50th day [(46.97±5.00) ng/L vs (11.27±2.67) ng/L, (41.95±5.51) ng/L vs (16.31±1.64) ng/L, P＜0.05]. The IL-17A level was positively correlated with 24-hour urinary protein in model group (r＝0.557, P＝0.021). Conclusion Bacteria FimH protein can induce glomerular focal necrotic lesion and lung injury in WKY rats, and IL - 17Amay involve in the damage process.     

亲属活体供者供肾前后肾功能的变化

目的 观察亲属活体供者供肾前后肾功能的变化.方法 102名供者均经过严格的术前筛选及评估,其中男性32名,女性70名,供肾时年龄为34～62岁,平均为51.7岁.采用腹腔镜切取供肾74例,开放手术切取供肾28例;其中取左肾90例,取右肾12例.术后对供者进行长期随访,收集术后1 d、7 d、14 d、1个月、3个月、6个月及每年的随访检测资料,检测内容包括血常规、尿常规、血清肌酐(Cr)和尿素氮(BUN)及肾小球滤过率(GFR)等,观察术后不同时期肾功能的变化情况,并与术前进行比较.结果 102例亲属活体供肾切取术均获得成功,术后随访时间为3～99个月,平均37.85个月,供者均健在.供肾术后早期供者的血红蛋白和红细胞计数有所下降,但分别在术后1周和2周后恢复至术前水平;供者的血清Cr水平均有不同程度的升高(P<0.05),但未超出正常范围;除术后第1天供者的血清BUN水平较术前有所升高外(P<0.05),其他随访时间血清BUN水平与术前比较,差异均无统计学意义(P>0.05);术后供者的GFR较术前均有不同程度的升高,从术后2周开始,与术前比较,差异均有统计学意义(P<0.05),其中以术后3个月时的增幅最大;术后各随访时间均未检测出尿蛋白定性呈阳性的供者.结论 活体供肾后,供者的血清Cr水平虽较术前有不同程度的升高,但未超出正常范围,GFR呈代偿性增高,活体供肾是安全的.     

Prediction of acute kidney injury complicated by sepsis with sTREM - 1 and NGAL as early marker

Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM - 1) and urinary neutrophil gelatinase - associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis. Methods A total of 141 eligible patients were enrolled in this prospective study. Blood and urine samples were collected at different time points as soon as sepsis was diagnosed. The concentrations of serum creatinine (Scr), urine sTREM-1 and NGAL were measured. According to AKI criteria, patients were divided into the AKI group and non - AKI group. Dynamic changes of levels of Scr, urine sTREM-1 and NGAL were observed in two groups. The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL. Results Among 141 septic patients, 44 (31.2%) cases had concomitant AKI. Twenty four hours after sepsis diagnosed, the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6±15.3) μmol/L, P＜0.05], which met the diagnostic criteria of AKI. In the AKI group, urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9±14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L, both P＜0.05].And at the following time points, urinary concentrations of sTREM - 1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P＜0.05). At 8 h time point, the area under the curve of urine sTREM-1 was 0.877 (95%CI 0.756-0.914), the sensitivity was 89.1% and specificity was 82.0% with a cutoff value of 70 ng/L. At 8 h time point, the area under the curve of urine NGAL was 0.862 (95% CI 0.703-0.958),the sensitivity was 87.4% and specificity was 85.5% with a cutoff value of 90 μg/L. Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr. Therefore, urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.     

Renal function before and after unilateral nephrectomy in renal donors.

Measurements of glomerular filtration rate (GFR), effective renal plasma flow (ERPF), tubular maximum reabsorption of glucose (Tmglucose) and secretion of para-aminohippurate (Tmpah), clearance of inorganic phosphate (Cphosphate) and uric acid (Curic acid), urine diluting capacity (CH2O) and urinary net acid excretion (UH + V) were made before and 10 to 14 days after unilateral nephrectomy in seven healthy renal donors. Comparisons were made between the functions of the remaining kidney and 50% of pre-uninephrectomy values. Mean post-uninephrectomy GFR increased by 36%, and mean ERPF, 55%. Tmglucose, Tmpah, Cphosphate, uric acid, CH2O, UH + V increased significantly, after uninephrectomy. The increase in Tmpah, Tmglucose and CH2O is proportional to the rise in GFR while the increase in Cphosphate, Curic acid and UH + V is proportionally greater than the increase in GFR. The changes in post-uninephrectomy renal handling of phosphate are not due to an increase in parathyroid hormone secretion.     

IgG4相关性疾病泌尿系统损害的临床特点分析

目的 总结和分析IgG4相关性疾病(IgG4-RD)泌尿系统损害的临床特点.方法 收集24例IgG4相关性疾病泌尿系统损害患者的临床资料,回顾性分析患者肾脏受累、治疗前后Scr、Hb、炎性反应指标和IgG4亚类水平的变化情况.结果 2010年8月至2014年5月经北京协和医学院肾内科确诊的IgG4相关性疾病泌尿系统损害病例24例,平均受累器官数目(4.38±1.55)个.治疗前血清IgG4[M(范围)]为12 750(1 460～ 59 400) mg/L,均伴炎性反应指标明显升高.20例患者有检测尿蛋白量,其中19例尿蛋白量升高,6例伴肾病综合征.21例患者Scr升高,均值为(410.48±352.17) μmol/L,其中3例需接受透析治疗.14例患者伴贫血,8例伴单侧或双侧肾脏体积缩小.21例Scr升高的患者中,11例患者肾功能不全因肾后性梗阻所致,3例病理证实为肾小管间质肾炎.与治疗前相比,24例患者糖皮质激素联合或不联合免疫抑制剂治疗1周后Scr明显下降(P＜0.05),治疗1个月后Scr下降更为明显(P＜0.01),3例透析患者均脱离透析.血沉于治疗1个月后亦明显下降(P＜0.01).IgG4亚类水平在治疗1个月时无显著下降(P＞0.05),治疗2个月时明显下降(P＜0.01).结论 IgG4相关疾病合并肾功能不全并不少见,对中至大量糖皮质激素治疗反应良好,治疗后Scr下降早于血沉和IgG4亚类.     

Health Status and Renal Function Evaluation of Kidney Vendors: A Report from Pakistan

Unrelated kidney transplants have lead to commerce and kidney vending in Pakistan. This study on 104 vendors reports demographics, history, physical and systemic examination, ultrasound findings, renal and liver function and GFR by Cockcroft-Gault. Results were compared with 184 age, sex and nephrectomy duration matched living-related donors controls. Comparison of vendors versus controls showed mean age of 30.55 ± 8.1 versus 30.65 ± 7.85 (p = 0.91) years, M:F of 4.5:1 versus 4.2:1 and nephrectomy period of 33.89 ± 30 versus 32.01 ± 29.71 (p = 0.60) months respectively. Of the vendors 67% were bonded laborers earning <50 $/month as compared to controls where 68% were skilled laborers and self-employed earning >100 $/month. History of vendors revealed jaundice in 8%, stone disease in 2% and urinary tract symptoms in 4.8%. Postnephrectomy findings between vendors versus donors showed BMI of 21.02 ± 2.8 versus 23.02 ± 4.2 (p = 0.0001), hypertension in 17% versus 9.2% (p = 0.04), serum creatinine (mg/dL) of 1.17±0.21 versus 1.02 ± 0.27 (p = 0.0001), GFR (mL/min) of 70.94 ± 14.2 versus 95.4 ± 20.44 (p = 0.0001), urine protein/creatinine of 0.150 ± 0.109 versus 0.10 ± 0.10 (p = 0.0001), hepatitis C positivity in 27% versus 1.0% (p = 0.0001) and hepatitis B positive 5.7% versus 0.5% (p = 0.04), respectively. In conclusion, vendors had compromised renal function suggesting inferior selection and high risk for developing chronic kidney disease in long term.     

Serum cystatin C--a superior marker of rapidly reduced glomerular filtration after uninephrectomy in kidney donors compared to creatinine

AIMS: Acute renal failure (ARF), defined by a rapid decrease of glomerular filtration rate (GFR), is associated with high mortality. Early and accurate detection of decreasing GFR is critical to prevent the progression of ARF and to potentially improve its outcome. Serum creatinine, the conventional GFR marker, has major limitations. We prospectively evaluated whether serum cystatin C detected a rapid GFR decrease earlier and more accurately than serum creatinine. METHODS: In ten patients undergoing nephrectomy for living related kidney transplantation, serum creatinine and cystatin C were determined daily. The decrease of GFR was quantitated preoperatively by creatinine clearance and MAG3 scintigraphy. The GFR decrease was defined by a 50-100% increase of cystatin C or creatinine from preoperative values. Ten patients without renal impairment served as controls. RESULTS: Initially, patients had a creatinine clearance of 105 +/- 14 ml/min/1.73 m2. Due to nephrectomy, patients lost 45 +/- 3% of their renal function. Serum cystatin C significantly increased already one, serum creatinine two days after nephrectomy. Cystatin C demonstrated an increase by 50-100% 1.4 +/- 0.9 days earlier than creatinine (p = 0.009). Serum cystatin C performed well detecting the GFR decrease with higher diagnostic values compared to creatinine. This was indicated by a sensitivity of 50, 70 and 80% of cystatin C to detect the GFR decrease on the three days following nephrectomy. CONCLUSIONS: Serum cystatin C detects rapid GFR decreases one to two days earlier than creatinine. Cystatin C is an early and accurate marker to detect rapid GFR decreases as in ARF.