Obstructive polyuric renal failure following renal transplantation

In a previously nephrectomized patient with a well functioning renal allograft, acute renal failure with massive polyuria and hypertension developed. Relief of a periureteric obstruction resulted in rapid correction of all three. Pathogenesis of hypotonic polyuria is thought to be a defect in the collecting duct permeability to water, simulating nephrogenic diabetes insipidus. Normal urinary dilution and acidification suggest intact function of the ascending loop of Henle and distal convoluted tubules. The quick reversal of polyuria and renal failure after obtaining relief of the obstruction suggest that both the decrease in the glomerular filtration rate and tubular dysfunctions are due to functional changes in the nephron rather than to organic damage, a possibility also borne out by the findings in a renal biopsy specimen showing normal glomeruli and intact tubular epithelial cells. Ureteric obstruction should be considered in any patient with renal failure and polyuria; it may be a correctable cause of hypertension.     

The influence of catheter-based renal sympathetic denervation on renal function and renal arteries

ObjectiveCurrently investigated non-pharmacological minimally invasive method for the treatment of resistant hypertension is percutaneous denervation of renal sympathetic nerve fibres by radiofrequency catheter-based ablation. We assessed its influence on renal function and renal arteries.MethodsThe first 38 patients treated with catheter-based renal denervation at our centre between September 2011 and December 2012 were included in the study. Changes in renal function and changes in renal artery morphology at 12 months after the procedure have been analyzed.ResultsMean age was 57.6 ± 11 years, the majority (63.9%) were men. Average estimated glomerular filtration rates (eGF) were 1.25 ml/s/1,73 m² before denervation and 1.30 ml/s⁻¹/1.73 m⁻² 12 months after intervention. Changes in eGF did not reach statistical significance. New haemodynamically non-significant renal artery stenosis (40%) has occurred in only one case after procedure.ConclusionIn agreement with the results of several studies, our findings suggest that renal denervation (RDN) appears to be a safe therapeutic approach.     

肾小管和肾间质疾病及肾血管疾病的病理学

肾小管和肾间质是肾脏的重要功能和结构成分,两者的关系密切,各级肾小管通过吸收和分泌,将原尿改造为终尿,肾间质有丰富的毛细血管和淋巴管,将肾小管吸收的水分、电解质等有用成分转运回体液.所以,肾小管的损伤必然导致肾间质的病变,同样,肾间质的病变也必然引起肾小管的继发性损伤,换言之,没有不伴肾间质损伤的肾小管疾病,也没有不伴肾小管损伤的肾间质疾病.     

老年肾脏病患者行肾活检的临床表现及肾脏组织病理分型

目的 分析老年肾脏病患者的临床表现及肾脏组织病理学分型.方法 回顾性分析2016年1月至2020年12月在空军军医大学西京医院进行肾活检的老年肾脏病患者的流行病学特征、临床表现及肾脏组织病理分型.采用SPSS 19.0软件进行数据分析.结果 在4386例接受肾脏活检的患者中,共纳入老年肾脏病患者(≥65岁)360例,其...     

Nifedipine-induced renal dysfunction. Alterations in renal hemodynamics

Nifedipine caused acute, reversible deterioration in renal function in four patients with chronic renal insufficiency. The absence of hypotension, clinical course, benign urinary sediments, and normal results of renal ultrasound examinations excluded acute tubular necrosis, pyelonephritis, interstitial nephritis, obstructive uropathy, and acute glomerulonephritis. It is postulated that this slow calcium channel blocker produced deleterious intrarenal hemodynamic alterations in the setting of moderate to severe renal functional impairment. Nifedipine may alter renal function by blocking calcium entry into renal vascular smooth muscle, thereby reducing the efficacy of vasoconstrictor hormones in regulation of renal blood flow and glomerular filtration rate. An alternative explanation is that nifedipine may inhibit the compensatory synthesis of vasodilatory prostaglandin E2 analogous to the clinical observation of acute deterioration in renal function by nonsteroidal anti-inflammatory drugs in patients with pre-existing renal insufficiency. These observations suggest that clinicians should monitor renal function closely and exercise caution when administering nifedipine to patients with underlying renal insufficiency.     

移植肾常规活检肾组织C4d沉积的检测及其意义

目的：观察C4d在肾移植术后常规活检组织中沉积发生情况及临床意义。方法：294例移植肾功能正常者（男211例，女83例）于术后2～4周内接受常规活检，应用间接免疫荧光检测肾组织C4d的沉积。观察CAd阳性患者病理特点、预后以及移植肾功能情况。结果：“无症状”CAd阳性检出率为6．12％（18／294）。其中弥漫分布2．38％（7／294），局灶分布3．74％（11／294）。该组患者除女性多数术前有妊娠史外（6／8），术前皆无高群体反应性抗体（PRA，panel reactive antibodes）、二次移植、输血等排斥高危因素的存在。随访12月，除1例患者因术后肺部感染救治过程中移植肾受损伤，其余17例患者肾功能稳定。该组患者移植肾组织中除1例出现动脉内膜炎外，并未发现动脉纤维素样坏死、动脉血栓、间质出血、透壁性动脉炎等组织形态学改变。术后起始免疫抑制方案11例为他克莫司（FK506）＋霉酚酸酯（MMF）＋激素，7例为环孢素A（CsA）＋MMF＋激素。8例患者行重复移植肾活检，其中6例CAd转阴，1例CAd由弥漫转为局灶阳性。结论：“无症状”CAd阳性患者术前多无发生排斥反应的高危因素，术后移植肾功能稳定，而移植肾组织中无抗体介导体液性排斥反应的特征性组织学改变。在接受免疫抑制治疗后，CAd在肾组织中的沉积可以消失或减弱。     

粥样硬化性肾动脉狭窄与肾功能之间的关系探讨

目的评价粥样硬化性肾动脉狭窄患者肾功能与肾动脉狭窄之间的关系。方法97例经造影明确的粥样硬化性肾动脉狭窄患者,根据肾动脉狭窄程度分组,测定肌酐清除率,并对其中20例患者行同位素肾图测定分肾肾小球滤过率。结果肾动脉狭窄〈50%组和狭窄≥50%组中肾功能正常者分别占49.1%和47.6%,与肾动脉正常组（占71.4%）比较有统计学差异（P〈0.05）;肾小球滤过率在肾动脉狭窄〈50%、50%-70%及≥70%组分别为（71.14±18.95）、（67.22±18.58）和（64.11±26.33）ml/min,组间比较无统计学差异（P〉0.05）;分肾肾小球滤过率与肾动脉狭窄程度之间无明显相关性（r=-0.208,P〉0.05）。结论肾动脉狭窄患者发生肾功能不全的可能性增大,但肾动脉狭窄程度的轻重不是影响肾功能的主要因素,肾实质损害可能在肾功能不全发病中起主要作用。     

Percutaneous transluminal renal stenting for transplant renal artery stenosis

Objectives : Renal transplantation is a well‐accepted therapeutic option for patients with end stage renal disease. Renal artery stenosis occurring in a transplanted kidney is a potentially serious condition and adversely affects graft survival and prognosis. The objective of this study is to document the immediate and intermediate term clinical results of renal stenting in this rare subset of renal artery stenosis. Background: There is limited data about the effectiveness of renal stenting in transplant renal artery stenosis. Methods : Eight patients, aged between 22 and 51 (42.5 ± 9.25) years, were referred to our tertiary care interventional cardiology services for renal intervention. The diagnosis of transplant renal artery stenosis was based on clinical presentation (uncontrolled hypertension (n = 4, 50%), worsening renal function (n = 3, 37.5%) or flash pulmonary oedema (n = 1, 12.5%)] and Doppler ultrasound. Results : All patients had live donor renal transplant using end to end anastomosis 2 to 11 (6.25 ± 3.24) months prior to intervention. Angiography revealed discrete stenosis at the anastomotic site. Intrarenal stenting performed from femoral access using 6 F accessories produced excellent angiographic results. There were no access site or procedure related complications. The intervention produced excellent immediate and intermediate term clinical results. In three patients, there was stabilization of renal function during 62 ± 9.16 months of follow‐up with decrease in serum creatinine by 38.86 ± 6.62 %; P = 0.0476. In four patients with refractory hypertension, excellent blood pressure control was achieved with a reduction in mean blood pressure by 25.95 ± 5.48 mm Hg (from 122.4 ± 5.7 to 96.45 ± 2.45 mm Hg; P = 0.0002) during 65.25 ± 23.79 months follow‐up. There was decrease in antihypertensive drug requirement from 3.75 ± 0.5 to 1.75 ± 0.5. During follow‐up, Doppler ultrasound documented a high peak systolic velocity in one asymptomatic patient with well controlled blood pressure and preserved renal function. Sustained benefits of percutaneous revascularization were supported by normal Doppler parameters in the remaining patients. Conclusions : Percutaneous renal stenting provides excellent angiographic and clinical results sustained at intermediate term follow‐up in patients with symptomatic transplant renal artery stenosis. © 2011 Wiley‐Liss, Inc.