移植肾急性抗体介导排斥反应中半乳糖凝集素7的表达CSCD

背景:半乳糖凝集素家族蛋白在移植免疫调节中的作用已被提出,目前尚未有半乳糖凝集素7检测对于肾移植后围手术期移植肾功能不全的辅助诊断,对肾移植受者而言,监测半乳糖凝集素7可能及早发现移植后肾功能异常,为临床治疗争取时间。目的:检测半乳糖凝集素7在移植肾急性抗体介导性排斥反应中的表达。方法:选取同种异体肾移植后行移植肾穿刺活检诊断为急性抗体介导性排斥反应的患者27例,同时选取同期移植后肾病理穿刺经诊断为正常的患者10例做对照。应用免疫组织化学染色法检测半乳糖凝集素7在组织中的表达情况、应用Western Blot法检测各组血清半乳糖凝集素7蛋白表达水平差异。结果与结论:免疫组织化学正常组光镜下半乳糖凝集素7表达于近曲小管上皮细胞表面微绒毛,肾小球、远曲小管、集合管和静脉未见其表达;急性抗体介导的体液性排斥反应组光镜下肾小动脉内膜水肿,管壁纤维素样坏死,肾小球肾小管淋巴细胞和单核细胞浸润,半乳糖凝集素7仅见于近曲小管上皮细胞表面微绒毛,同时动脉平滑肌也有表达,阳性度较高。急性抗体介导的体液性排斥反应组半乳糖凝集素7阳性细胞计数显著高于正常对照组(P<0.01)。Western Blot检测结果,急性抗体介导的体液性排斥反应组血清半乳糖凝集素7的表达高于正常对照组(P<0.05)。结果说明,移植肾穿刺病理活检安全可靠,对患者及移植肾无不良影响,半乳糖凝集素7检测对于肾移植后围手术期移植肾功能不全的辅助诊断具有重要的指导意义。     

移植肾急性抗体介导排斥反应中半乳糖凝集素7的表达

背景:半乳糖凝集素家族蛋白在移植免疫调节中的作用已被提出,目前尚未有半乳糖凝集素7检测对于肾移植后围手术期移植肾功能不全的辅助诊断,对肾移植受者而言,监测半乳糖凝集素7可能及早发现移植后肾功能异常,为临床治疗争取时间。目的:检测半乳糖凝集素7在移植肾急性抗体介导性排斥反应中的表达。方法:选取同种异体肾移植后行移植肾穿刺活检诊断为急性抗体介导性排斥反应的患者27例,同时选取同期移植后肾病理穿刺经诊断为正常的患者10例做对照。应用免疫组织化学染色法检测半乳糖凝集素7在组织中的表达情况、应用Western Blot法检测各组血清半乳糖凝集素7蛋白表达水平差异。结果与结论:免疫组织化学正常组光镜下半乳糖凝集素7表达于近曲小管上皮细胞表面微绒毛,肾小球、远曲小管、集合管和静脉未见其表达;急性抗体介导的体液性排斥反应组光镜下肾小动脉内膜水肿,管壁纤维素样坏死,肾小球肾小管淋巴细胞和单核细胞浸润,半乳糖凝集素7仅见于近曲小管上皮细胞表面微绒毛,同时动脉平滑肌也有表达,阳性度较高。急性抗体介导的体液性排斥反应组半乳糖凝集素7阳性细胞计数显著高于正常对照组(P0.01)。Western Blot检测结果,急性抗体介导的体液性排斥反应组血清半乳糖凝集素7的表达高于正常对照组(P0.05)。结果说明,移植肾穿刺病理活检安全可靠,对患者及移植肾无不良影响,半乳糖凝集素7检测对于肾移植后围手术期移植肾功能不全的辅助诊断具有重要的指导意义。     

移植肾血管变异的临床处理

背景：血管吻合技术的好坏直接关系到肾移植的成败。 目的：提高肾移植变异血管吻合的技术方法。 方法：1999年9月至2010年12月广东省第二人民医院器官移植科共完成878例肾移植,对其中供肾存在的动静脉血管变异进行修整、合并、延长等重建处理后进行移植,副肾动脉采用改良支架支撑法同腹壁下动脉吻合。 结果与结论：878例肾移植中,55例供肾动脉变异,肾静脉变异22例,经血管修整重建后均成功与受者髂内或髂外血管吻合。23例直径大于1 mm副肾动脉与腹壁下动脉吻合均取得成功。移植后彩超显示肾动静脉吻合口血流及副肾动脉血流正常。提示移植肾血管变异及副肾动脉只要正确处理,吻合得当,可以安全有效地移植给受者并获良好效果。     

用微分离方法培养肾皮质近曲肾小管和髓质集合管上皮细胞及其生物学特征的研究

在肾间质发病过程中 ,各段肾小管上皮细胞受到的侵害和发挥的作用不同。为了探讨不同节段肾小管上皮细胞的生物学特征 ,作者利用微分离的方法在解剖显微镜下获取肾脏皮质近曲小管和髓质集合管进行体外培养 ,分别得到了纯净的近曲小管和集合管上皮细胞。通过细胞免疫组化和耐高渗实验方法对该两种细胞进行区分和鉴定 ,利用 EL ISA和细胞株依赖方法检测了该两种上皮细胞表达血管紧张素 IIAT- 1受体和分泌白细胞介素 - 6( IL-6)的情况。结果 :近曲小管上皮细胞 AT- 1受体的分布和分泌 IL- 6的量均显著高于集合管上皮细胞 ;在血管紧张素II刺激下 ,近曲小管上皮细胞产生的 IL- 6明显增加 ,而集合管上皮细胞则无明显改变。结论 :近曲小管和集合管上皮细胞在炎症介质的产生上具有不同的生物学特征     

扬子鳄胚胎后肾发生的组织学及细胞化学观察

目的：通过对扬子鳄胚胎后肾组织发生过程的观察,探讨其后肾发生及分化的规律和特点。材料与方法：用组织学及细胞化学染色法,在光镜下对９个不同发育时期的胚胎进行了观察。结果：孵育第１８天,从泄殖腔附近发出的输尿管芽向生后肾组织侵入生长,生后肾组织产生许多生后肾小泡。第２４天出现集合管及肾小管、肾小囊的雏形。第３０天肾小管显著伸长并发生折叠,出现近曲小管、远曲小管和肾小管中间段的形态分化。第４０￣６２天,肾小体逐渐发育成熟,肾小管各段逐步出现机能分化。在后肾发育过程中,ＰＡＳ阳笥物质首先出现于集合管上皮细胞,其次是远曲小管,最后是肾小管中间段和近曲小管。第２４￣３０天中,集合管、肾小管及肾小囊上皮细胞中ＲＮＡ含量均丰富,呈弥散型分布,第４０天以后肾组织中ＲＮＡ含量迅速减少。结论：扬子鳄后肾不同区域肾单位的发生与分化存在     

四氯化碳诱导大鼠肾细胞凋亡的研究

目的观察四氯化碳（CCl4）诱导大鼠肾形态结构和肾细胞凋亡的变化。方法将健康雄性Wistar大鼠随机分为对照组、2周CCl4组和6周CCl4组,每组5只。对照组背部皮下注射橄榄油（0．12ml／100g鼠重）,CCl4组以0．3ml／100g鼠重背部皮下注射60％CCl4橄榄油。2周CCl4组和6周CCl4组大鼠分别于实验的第3周和7周的第1d处死。肾石蜡切片苏木精．伊红染色,光镜观察肾组织形态学,免疫组织化学显示Caspase-3、Bax、TUNEL观察肾细胞凋亡。结果对照组肾小球和肾小管结构均正常。2周和6周CCl4组的肾小球结构正常,2周CCl4组病变较轻、6周CCl4组肾皮质近端小管管腔狭小,上皮细胞浊肿,空泡变性,微绒毛脱失。对照组和2周CCl4组Caspase-3、Bax免疫组织化学显色未见阳性细胞表达;而6周CCl4组则在近髓质处的皮质内,近端小管上皮细胞的胞质呈现棕黄色阳性反应。TUNEL显色2周CCl4组可见肾皮质内近端小管上皮细胞核和少量的肾小球细胞核呈阳性表达,而6周CCl4组在大量的远曲小管及少量近端小管的上皮细胞核呈阳性表达。结论CCl4诱导性肾损伤大鼠,2周时肾组织的近端小管上皮及少量肾小球毛细血管内皮细胞发生凋亡,而损伤6周时,肾皮质近端小管受损,上皮细胞变性;远曲小管上皮细胞发生凋亡。     

夫妻间活体供肾移植

背景：近几年随着各项移植法规相继出台,中国做为器官移植大国,发展迅速,除了尸体肾移植外,活体肾移植亦得到健康快速发展,夫妻供肾做为没有直接血缘关系的活体移植,在器官移植界占据着重要地位。 目的：观察夫妻间供肾亲属活体肾移植的疗效。 方法：郑州人民医院器官移植科2008-10/2010-09进行夫妻间供肾移植11例,同期尸体供肾肾移植83例为对照组。两组受者均采用供肾静脉与髂外静脉端侧吻合,供肾动脉与髂内动脉端端吻合,输尿管-膀胱乳头式吻合,隧道包埋。免疫抑制诱导方案采用甲基泼尼松龙,基础免疫抑制采用钙调磷酸酶抑制剂(他克莫司或环孢素)、吗替麦考酚酯、肾上腺皮质激素(激素)三联免疫治疗,根据血药谷浓度调整他克莫司或环孢素的用量。移植后6个月内进行随访,评价两组受者移植后的肾功能恢复及早期并发症发生情况。 结果与结论：肾移植后两组急性排斥反应、移植物功能延迟恢复等早期并发症发生率比较,夫妻肾移植组优于尸体肾移植组,差异有显著性意义(P < 0.05)。结果提示夫妻间肾移植由于移植前准备充分,肾脏缺血时间短及夫妻间长期共同生活产生相应的免疫耐受,其疗效优于同样无血缘关系的尸体供肾移植。     

亲属活体肾移植供肾多支动脉的重建

背景:近年来亲属活体肾移植在国内开展增多,供肾动脉血管变异较为常见,因此需重视动脉重建的方法,以保证手术的合理性和安全性。在临床实践中发现供肾多支动脉的情况较为常见,而亲属活体肾移植国内刚刚起步,相关经验尚少。目的:总结亲属活体供肾多支动脉的血管重建方式在肾移植中的应用经验。方法:2006-01/2008-12完成38例亲属活体肾移植,其中供肾单支动脉30例,多支动脉8例。术中证实多支动脉供肾中5例供者2支动脉变异,2例供者3支动脉变异,1例供者4支动脉变异。多支动脉供肾分别采用侧侧共干吻合或端侧吻合后分别与髂内动脉或髂外动脉吻合。观察肾移植手术结果及近期随访结果。结果与结论:8例多支动脉供肾者肾移植后7～10d出院,均未输血,未出现并发症。受者肾移植后随访6～36个月,平均13个月,未见急性肾小管坏死、肾血管栓塞、肾动脉狭窄、假性动脉瘤等并发症,彩色多普勒超声检查示移植肾血供均良好。多支动脉供肾组受者吻合血管开放后泌尿时间、血肌酐水平与单支动脉供肾组差异均无显著性意义(P0.05)。提示选择合适方法进行血管重建,不会影响肾移植效果,采用受者的髂内动脉及其分支进行血管重建安全可行。     

肾移植及移植后的血管并发症

背景：尽管肾移植手术技术已相当成熟,但各移植中心难免会出现术中及术后的血管并发症。 目的：分析肾移植过程中及移植后血管并发症的诊断与处理。 方法：回顾性分析 11 例肾移植过程中、移植后血管并发症资料。移植过程中并发症：动脉吻合口狭窄2例,肾静脉横断1例,髂外动脉硬化斑块剥脱堵塞肾动脉3例,移植肾静脉扭曲1例;移植后并发症：肾外型假性动脉瘤2例,吻合口狭窄1例,移植肾动脉压迫梗阻1例。 结果与结论：肾移植中吻合口狭窄2例移植后恢复良好,分别于移植后6年及11年移植肾失功;肾静脉横断1例随访12年移植肾失功;髂外动脉硬化斑块剥脱堵塞肾动脉3例,1例移植肾当即失功,另2例分别随访6年及2年,现移植肾功能良好;移植肾静脉扭曲1例移植后出现移植肾功能延迟恢复,1个月后因重症肺部感染死亡。移植后发生的血管并发症中肾外型假性动脉瘤2例移植肾均失功;吻合口狭窄1例经置入支架后肾功能恢复正常,已随访18个月;移植肾动脉压迫梗阻1例移植后出现移植肾功能延迟恢复,3周后因重症肺部感染死亡。结果说明肾移植过程中及移植后发生血管并发症,只要诊断准确、处理及时,可取得比较满意的治疗效果。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

双J管在活体亲属肾移植术中的应用

目的:探讨活体亲属肾移植手术中应用双J管在预防并发症、促进移植肾功能恢复中的作用.方法:回顾2007年～2011年活体亲属肾移植术中留置双J管的9例患者临床资料,2例为移植(肾)输尿管和受者输尿管吻合,7例均为移植(肾)输尿管和受者膀胱吻合;其中移植肾放置于髂窝后输尿管扭曲3例,吻合口周围组织水肿、渗血致解剖层次不清1例,输尿管吻合后张力过高2例,输尿管壁薄、血供不佳1例.分析其术后移植肾功能恢复和并发症发生情况.结果:所有置管患者术后均未出现吻合口漏尿;移植肾功能顺利恢复正常,术后1月前后拔管,半年内复查B超提示移植肾无积水,吻合口无狭窄.2例术后出现肉眼血尿,1例尿中出现白细胞,经对症处理治愈.结论:在活体亲属肾移植术中,选择性留置双J管对防止出现术后并发症、促进肾功能恢复非常必要.     

脑死亡供体肾脏病理改变及移植应用标准评判的探讨

目的探讨脑死亡供体肾脏病理改变及对临床使用的指导意义。方法对13例脑死亡供体26个肾脏进行了穿刺活检,做HE染色、网状纤维染色及PAS染色。结果发现大多数患者均有不同程度的近曲小管坏死,而远曲小管、肾小球、基底膜多无改变。选择肾近曲小管上皮细胞坏死〈50%、肾小球无明显改变、肌酐〈250μmol/L、年龄〈55岁的供体26个肾脏施行了移植,均取得成功。结论脑死亡供体肾脏根据穿刺病理活检改变并结合临床表现可以作为临床移植的评判依据。     

Regression of glycogen nephrosis in experimental diabetes after pancreatic islet transplantation

Glycogen nephrosis, i.e. the Armanni-Ebstein lesion which manifests itself by intracellular accumulation of beta-glycogen has been studied in two groups of streptozotocin diabetic rats and compared to controls. One diabetic group was left untreated and the other diabetic group received pancreatic islet transplantation after 4 weeks duration of diabetes. The kidneys were studied after another 4 week period with normoglycemia. In the non-transplanted diabetic animals glycogen containing tubules comprised 43% of the distal tubule length in the cortex but in the transplanted animals no abnormal, glycogen containing cells could be recovered at the light microscope level. Measurements of the total distal tubule length in the non-transplanted diabetic animals showed that the distal tubules increased in length by 24%. In the transplanted diabetic animals distal tubule length remained the same as in the non-transplanted diabetic animals in spite of normalization of the tubular morphology. This finding could possibly be responsible for the incomplete normalization of kidney weight after treatment.     

The changes of calretinin immunoreactivity in paraquat-induced nephrotoxic rats

Calcium-binding proteins are present in the kidneys: calbindin D-28k in the distal tubules and calretinin in the proximal tubules. Since paraquat causes degeneration in the brush border-bearing proximal tubule cells in rat kidneys, we investigated the changes of calretinin immunoreactivity in the proximal tubule cells of paraquat-induced nephrotoxicity in experimental male Sprague-Dawley rats following chitosan oligosaccharide pretreatment to investigate its protective properties. Paraquat (60mg/kg) was administered intraperitoneally with or without chitosan oligosaccharide (500mg/kg, p.o.) pretreatment. The changes on calretinin were compared with those of calbindin D-28k by immunohistochemistry and Western Blot analysis. Calretinin was immunolocalized on the apical surface of proximal tubule cells in the deeper cortex of normal kidney, and disappeared after paraquat administration with minor changes of calbindin D-28k immunoreactivity in the distal tubules and collecting ducts. Chitosan oligosaccharide pretreatment caused increased expression of calretinin and calbindin D-28k before paraquat injection and helped preserve proximal tubules after paraquat treatment. However, Western blot analysis on calretinin and calbindin D-28k could not explain the degeneration of the proximal tubule cells in paraquat-induced nephrotoxicity. These findings suggested that calretinin is a possible and more useful histopathological marker for proximal tubule cells in paraquat-induced nephrotoxic rats.     

大鼠肾移植1 000例经验总结

目的：对大鼠肾移植进行经验总结以指导实验与临床研究。 方法：作者在2004-01/2009-07海德堡大学移植中心期间,采用大鼠肾动、静脉与腹主动脉、腔静脉行端侧吻合。对于急性肾移植模型,输尿管直接植入膀胱内;对于慢性肾移植模型,输尿管采用端端吻合法。术中直接切除对侧肾脏,完成大鼠肾移植1 000例,并对其进行总结。 结果：只要供体肾脏冲洗良好,吻合时暖缺血时间小于30 min,手术时间60 min左右,吻合技术娴熟,移植成功率达98%以上。 结论：该实验模型安全、方便、可行。肾移植成功的关键是手术技术。     

Demonstration of ochratoxin A in kidneys of pigs and rats by immunofluorescence microscopy.

Ochratoxin A was localized in the kidney of pigs and rats by means of immunofluorescence microscopy after short-time exposure. Antibody against ochratoxin A was obtained from rabbits after repeated injections of bovine serum albumin-ochratoxin A conjugate. Ochratoxin A was localized exclusively in the proximal tubule. Light microscopically, necrosis and desquamation of epithelial cells in the pig kidneys were restricted to the proximal tubule where the toxin was found. The investigation had demonstrated conclusively that the proximal tubule is the target part of the nephron in ochratoxin A-induced mycotoxic nephropathy.     

肾移植后淋巴漏的原因分析

背景：近年来,肾移植后并发症明显降低,但移植后淋巴漏仍有很多报道。 目的：探讨肾移植后淋巴漏的原因。 方法：分析396例肾移植患者的临床资料,根据移植中髂血管周围有无肿大淋巴结分为淋巴结肿大组(n=21)和无肿大组(n=375),分析两组移植后淋巴漏的原因。 结果与结论：两组共发生淋巴漏27例,总发生率为6.82%。淋巴结肿大组5例,发生率为23.81%,移植后3 d出现淋巴漏,平均持续时间为23 d,淋巴液引流量日均为191 mL;无肿大组22例,发生率为5.87%,移植后8 d出现淋巴漏,平均持续时间为11 d,淋巴液引流量日均为96 mL。两组比较差异有显著性意义(P < 0.01)。淋巴结肿大组移植后病理诊断淋巴结结核1例,出现淋巴漏1例;反应性淋巴结肿大9例,出现淋巴漏1例;慢性淋巴结炎11例,出现淋巴漏3例;无淋巴结肿大组1例移植肾功能丢失,1例死亡。说明肾移植后淋巴漏与肿大淋巴结性质、手术操作、排斥及感染等因素有关,影响人肾存活。     

Micropuncture studies after temporary ischemia of rat kidneys

Summary Micropuncture experiments were carried out on rat kidneys subjected to temporary ischemia (TI). Unilateral TI was performed by clamping the blood supply to the left kidney for 60 min. Time period between TI and investigating the kidney ranged from 1 h to 13 days. In another series of experiments blood supply to the left kidney was severely diminished for 24 h by a clip.-39% of animals developed anuria of the experimental kidney; in the other animals, urine flow rate was markedly decreased after TI (P<0.02). Employing the tracer microinjection technique considerable amounts (51%-oliguric kidneys; 17%-nonoliguric kidneys) of¹⁴C-labelled inulin injected into a proximal tubule of the damaged kidney were found in the urine of the contralateral kidney indicating backdiffusion of inulin through the damaged tubular epithelium. The amount of inulin recovered from both kidneys was decreased. Backdiffusion of inulin was detectable up to seven days after TI. Under control conditions 2% of inulin injected was found on the contralateral side, inulin recovered from both kidneys being approx. 100%. Dye intensity of Lissamine-green passing through the nephron was decreased noticeably after TI. Proximal tubular diameter and proximal free-flow pressure showed a large variability, the means being not significantly differnt from controls.—The results indicate that the concurrence of at least two factors are involved in the pathogenesis of acute renal damage induced by TI: Backdiffusion of tubular fluid through the damaged tubular epithelium and a decrease of glomerular filtration rate. The measurement of the clearance of inulin in kidneys damaged by ischemia does not represent the actual GFR, but underestimates this value proportionately to the degree of backdiffusion of inulin.Supported by the Deutsche Forschungsgemeinschaft, SFB 90, CARVAS.     

Nephrotoxic action of rattlesnake and sea snake venoms: an electron-microscopic study.

The fine structure of renal corpuscles and proximal convoluted tubules of the right kidneys of Suiss mice were studied 9 hr after the injection of the venom of Crotalus atrox (Western diamond-back rattlesnake) or the venom of Laticauda semifasciata (broad-banded blue sea snake). Rattlesnake envenomation resulted in several ultrastructural changes in the renal corpuscles and proximal convoluted tubules. Visceral epithelial changes included intracellular oedema, blebbing, vesiculations, the formation of microvillus projections and dilatation of the endoplasmic reticulum and mitochondria. Changes in the parietal epithelium were similar except that no microvillus projections were noted. Mesangiolysis was a consistent finding. Collagenous fibrils were very prominent in the lysed areas of the mesangial cells. Increased numbers of lysosome-related structures were noted in the proximal convoluted tubule cells. Most of the nuclear cisternae of the cells of the renal corpuscles and proximal convoluted tubules were greatly dilated. Sea snake envenomation resulted in focal organellar swelling and focal intracellular oedema of the visceral epithelium. This venom did not affect the cells of the proximal convoluted tubule. The presence of light and dark visceral epithelial cells has been a consistent finding for both the control and the environmated groups.