移植相关人群对异种肾移植的态度及影响因素

目的 调查移植相关人群对于异种肾移植的态度及影响因素。 方法 2022年6月至2023年1月,对等待肾移植患者、肾移植术后患者、患者家属及医学生进行分层随机抽样,每个群体抽取400名,共1 600名进行自制问卷调查。分析受访者的一般资料、对异种肾移植的态度及不能接受异种肾移植的原因。分析受访者对异种肾移植态度的影响因素。 结果 共回收有效问卷1 493份,回收有效率93.31%。能接受同种异体肾移植手术的占93.10%;知晓异种肾移植的占66.78%。795名受访者表示“在异种肾移植与同种异体肾移植有着相同结果及风险时”能接受异种肾移植;698名表示“不能”或“不确定”能否接受异种肾移植（χ²=16.409,P=0.001）。698名表示“不能”或“不确定”能否接受异种肾移植的受访者中,在不符合同种异体肾移植的条件下,愿意接受异种肾移植的占10.9%;如果与同种异体肾移植相比,异种肾移植有着更小的风险及更好的预后的条件下,愿意接受异种肾移植的占35.8%;如果与同种异体肾移植相比,异种肾移植等待时间更短,愿意接受异种移植的占21.2%;如果与同种异体肾移植相比,异种肾移植花费更少,愿意接受异种肾移植的占24.5%。受访者不能接受异种肾移植的主要原因为担心手术风险及担心其他未知风险。多因素分析结果显示,长期居住在城镇的受访者、能接受同种异体肾移植的受访者、知晓异种肾移植的受访者对异种肾移植态度更积极。 结论  不同移植相关人群对异种肾移植态度存在差别,总体态度良好。积极推进异种肾移植的研究、开展相关科普教育有利于提高公众对异种肾移植的接受度。     

Application of percutaneous nephrolithotomy combined with da Vinci Xi robot in complicated upper urinary tract repair surgery: A case report

Duplex kidney and ureter is a congenital malformation. Few patients present with hydronephrosis caused by obstruction of the ureteropelvic junction of the duplex kidney, but lower kidney calculi caused by a duplex kidney abnormality is rare. This study reports a case of a duplex kidney and ureter complicated by multiple calculi in the duplex lower kidney. Percutaneous nephrolithotomy combined with a da Vinci robot-assisted laparoscopic upper urinary tract reconstruction was performed. The lower ureter was resected, and the lower kidney was preserved. One year after the surgery, a follow-up examination reported satisfactory renal function without hydronephrosis or calculi.     

Increased insulin-like growth factor-II tissue concentrations during compensatory kidney growth in infantile rats

Insulin-like growth factor (IGF)-I and IGF-II serum and kidney tissue concentrations were measured in compensatory kidney growth in infantile and adult rats. We hypothesized that the known switch from IGF-II in fetal life to IGF-I in adult life may be responsible for the different modes of compensatory kidney growth, which are mainly characterized by hyperplasia in infantile rats and hypertrophy in adult rats. While IGF-I serum concentrations increased with age in infantile rats, kidney tissue concentrations of IGF-I showed a similar increase in both age groups after uninephrectomy. In adult rats, serum and kidney tissue concentrations of IGF-II were unchanged by uninephrectomy. In infantile rats, however, a significant increase in both serum and kidney concentrations of IGF-II was observed with a maximum at day 5 after uninephrectomy. To investigate if compensatory kidney growth is dependent on hyperperfusion of the remnant kidney, the left renal artery was clipped in infantile rats. The clipped kidney showed growth retardation despite normal kidney tissue concentrations of IGF-I and IGF-II. The contralateral kidney was enlarged and IGF-II kidney concentrations were elevated. However, animals with one clipped kidney and nephrectomy of the contralateral kidney showed compensatory kidney growth of the clipped kidney combined with increased IGF-II kidney tissue concentrations. We conclude that IGF-II mainly promotes compensatory kidney growth in infantile rats by hyperplasia. Hyperperfusion of the remnant kidney seems to be unnecessary for initiation of compensatory kidney growth.     

Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury

Acute kidney injury increases mortality risk among those with established chronic kidney disease. In this study we used a propensity score-matched cohort method to retrospectively evaluate the risks of death and de novo chronic kidney disease after reversible, hospital-associated acute kidney injury among patients with normal pre-hospitalization kidney function. Of 30,207 discharged patients alive at 90 days, 1610 with reversible acute kidney injury that resolved within the 90 days were successfully matched across multiple parameters with 3652 control patients who had not experienced acute kidney injury. Median follow-up was 3.3 and 3.4 years (injured and control groups, respectively). In Cox proportional hazard models, the risk of death associated with reversible acute kidney injury was significant (hazard ratio 1.50); however, adjustment for the development of chronic kidney injury during follow-up attenuated this risk (hazard ratio 1.18). Reversible acute kidney injury was associated with a significant risk of de novo chronic kidney disease (hazard ratio 1.91). Thus, a resolved episode of hospital-associated acute kidney injury has important implications for the longitudinal surveillance of patients without preexisting, clinically evident kidney disease.     

Primary carcinoid tumor of the kidney: a case report

A 40-year-old male was referred to our hospital for further examination of a left kidney tumor. A left kidney tumor measuring 3 cm in diameter was incidentally found by abdominal ultrasound on physical checkup. Abdominal computed tomography and magnetic resonance imaging confirmed hypovascular tumor of the left kidney. Clinical diagnosis was left renal cell carcinoma and retroperitoneoscopic left nephrectomy was performed. However, pathological diagnosis was carcinoid tumor of the kidney. Primary carcinoid tumors of the kidney are uncommon. We present a case of primary carcioid tumor of the kidney and review the literature.     

The poor accuracy of indirect measurements of cadaveric donor kidney weights

Reports that examined the issue of whether transplantation of inadequate nephron mass may be a risk factor for long-term allograft failure yielded conflicting results. One of the more accurate methods of estimating glomerular mass is kidney weight. Most of the clinical studies used body surface area (BSA) or kidney length as estimates of kidney weight. To test the hypothesis that indirect measures of kidney weight are accurate estimates of kidney weight, we compared the kidney weight of 41 consecutive cadaveric kidneys to donor BSA, dimensions measured with calipers at the time of transplantation, and dimensions supplied by the Organ Procurement Agency (OPA). Linear regression analysis was used with kidney weight as the dependent variable and BSA, kidney length, or kidney volume as the independent variable. Kidney length measured with calipers was also compared to kidney length supplied by the OPA. Kidney weight had the best correlation with kidney volume and kidney length determined by caliper measurements (r = 0.640 and 0.646, respectively). The regression analysis showed that the correlation of kidney weight with BSA was 0.487. The correlation of OPA-provided kidney length with kidney weights was poor (r = 0.410). The linear regression of caliper-measured kidney length versus OPA length yielded a slope of 0.360, instead of an ideal slope of 1. The assumption has been made that kidney weight or a surrogate of kidney weight has an excellent correlation with nephron mass. Some of the variability in studies that attempted to examine the effect of transplanted nephron mass on allograft outcome may be due to inaccurate estimates used for kidney weight. Our data suggest that surrogate measurements of kidney weight may not be accurate. We recommend that measured kidney weight should be used in studies examining the effect of donor renal mass on allograft outcomes.     

The study of oliguric and polyuric acute renal failure

A simple laboratory model for acute renal failure (ARF) induced by warm ischemia was studied in an attempt to elucidate the mechanisms for oliguria. It was observed that unilateral warm ischemic injury with contralateral nephrectomy or bilateral warm ischemic injury resulted in a high output (polyuric) form of ARF. In contrast, when unilateral warm ischemic injury was induced and the contracolateral kidney was left intact, low output (oliguric) ARF was observed in the injured kidney. Ligation of the ureter of the normal contralateral kidney reversed the oliguric state. Replacement of the urine output by the normal kidney with Ringer's lactate solution failed to reverse the low output state in the injured kidney. Reinfusion of the urine itself from the intact contralateral kidney, while increasing urine output, did not entirely alleviate the oliguric phenomenon in the injured kidney during a 24-hr period during which the animals underwent volume expansion. Although the basis for the oliguria in the injured kidney when functioning renal tissue remains is unclear, indirect evidence suggests that the excretion of a diuretic factor in urine by the normal kidney contributes to the oliguria observed in the injured kidney.     

Diffuse Parenchymal Urine Leak After Kidney Transplantation Following Degloving Injury During Donor Nephrectomy

Laparoscopic donor nephrectomy can result in trauma to the kidney which may affect recipient graft function. In this case, the kidney sustained a complete degloving of the capsule during extraction. The kidney was transplanted and had immediate, good renal function, but postoperative course was complicated by a large urinoma that drained through the wound. Exploration was negative for a defined urine leak, but the surface of the denuded kidney was leaking a significant amount of unconcentrated urine. The patient was successfully treated with tissue glue treatment to the kidney surface and peritoneal window.     

7 cases of congenital multicystic kidney with special reference to its embryogenesis

We have experienced 7 cases of multicystic kidney. The latest two cases, etiologically of interest, are reported herein with special reference to its embryogenesis. Case 6: A 4-year-old girl was referred to our clinic for further evaluation of mild azotemia and nonvisualization of left kidney. Left kidney was strongly thought to be multicystic kidney from abdominal CT, whereas her contralateral kidney exhibited hydrocalycosis resembling infundibular stenosis with diminished calyceal numbers. Nephrectomy of her left kidney was performed and histological studies confirmed renal dysplasia (primitive duct, metaplastic cartilage, etc.). Case 7: A 7-year-old girl was referred to Hakodate Kyokai Hospital for the evaluation of azotemia and low stature. Her right kidney was not visualized on IVP and her left kidney exhibited hydronephrosis with diminished calyceal numbers. Her right kidney was diagnosed as multicystic kidney on CT-scan. Pyeloplasty of her left kidney was performed. Multicystic kidney is a rather rare congenital disease. Association of various anomalies in contralateral kidney has been emphasized as well as the notion that infundibulopelvic stenosis is a linked in the clinical spectrum extending from cystic dysplasia of the kidney to hydronephrosis. Our last two cases seem to be included in this category of obstruction theory. As shown by microdissection technique (Potter), however, severe ampullary inhibition early in fetal life is also an attractive hypothesis. Diminished calyceal number of contralateral kidneys seen in our recent two cases is compatible with possibility of ampullary damage. Recent experimental study also showed that renal dysplasia is not solely caused by simply mechanical obstruction to urinary drainage, even when the obstruction is imposed at an early stage of renal development.     

Transplantation of a Blue Kidney: A Case Report

A blue kidney, although very rare, can be encountered upon a live kidney donor. Literature has shown hemosiderin deposits, lipofuscin pigment, and melanosis as possible reasons. We report on a 37-year-old woman who wished to donate a kidney to her husband. The donor's preoperative biochemistry and imaging tests showed normal renal function. During the laparoscopic left kidney nephrectomy, the kidney was observed to be blue in color. Perioperatively, Doppler ultrasonography was used to rule out vascular reasons, and a wedge biopsy was performed. The other kidney was also explored, and it turned out to be blue as well. Histopathological analysis showed melanosis in the tubules without malignity or pathologic changes in the glomeruli, the interstitium, or the vessels. Even though some causes of blue kidney may result in impairment of the renal function, after the necessary tests show no signs of malignity and functional impairment, a blue-colored kidney may be suitable for transplantation.     

Transarterial renal embolization for enlarged horseshoe kidney

A 56-year-old Japanese man was admitted to our hospital with abdominal fullness in June 2006. He had been diagnosed as having a horseshoe kidney by computed tomography in January 2002. At that time, renal dysfunction (serum creatine: 2.0 mg/dl) was detected. Even after hemodialysis was started for end-stage renal failure in March 2006, his abdominal fullness became progressively worse. CT scanning showed a markedly enlarged horseshoe kidney. Transarterial embolization (TAE) was performed via the right renal arteries with 14 platinum microcoils; the left renal arteries were not embolized in order to preserve sufficient parenchyma and a urine volume of more than 1,000 ml daily. Two years after TAE, a decrease in the size of the left kidney was noted along with the right kidney. However, urine output was still more than 1,000 ml daily. It is possible that one kidney compressed the contralateral kidney, resulting in enlargement of both components of the horseshoe kidney and renal dysfunction. TAE may be a useful option for obstructive uropathy in patients with horseshoe kidney, which has conventionally been treated surgically.     

Doppler ultrasonography before and 6 to 12 months after kidney transplantation

INTRODUCTION: Ultrasound examination of the kidney is relatively inexpensive and provides a way to assess renal location, contour, and size. Doppler ultrasonography is a noninvasive tool for screening renal artery stenosis. It not only provides kidney morphology data, but also describes hemodynamic changes associated with renal artery stenosis, such as increased peak systolic velocity and decreased resistance index (RI). The aim of this study was to compare the Doppler ultrasonographic changes between the donor's kidney before transplantation and the recipient's kidney at 6 to 12 months after transplantation. METHODS: We compared the results of Doppler ultrasonography in 20 kidney donors and recipients before and 6 to 12 months after transplantation. For this purpose the size, cortical thickness, echogenicity, anastomosis, mean pulsatility index (MPI), and RI of the kidney were recorded in potential donors before transplantation and in recipients at 6 to 12 months after transplantation for statistical analysis. RESULTS: There was more than a 10-mm increase in transplanted kidney length 6 to 12 months after transplantation in 75% of recipients. There was also more than a 10-mm increase in the width of the transplanted kidney in 80% of recipients. There was no significant change in cortical thickness between the donor and the recipient of the kidney. MPI and RI increased slightly after transplantation. There was more than 50% anastomotic stenosis in only 10% of transplanted kidneys. CONCLUSION: There was significant enlargement of the kidney size with a nonsignificant increase in MPI and RI of the transplanted kidney. Anastomotic stenosis was also less significant in our study.     

Side effects of extracorporeal shock-wave exposure on the kidney in the dogs

The effects of extracorporeal shock-wave (SW) exposure on the kidney were investigated in dogs using a Dornier kidney lithotriptor HM3. The SW was generated by spark discharge at 20 KV and was focused on the lower part of either kidney. Before and after the exposure of 500 and 1000 shots of SW, the renal blood flow of the affected and contralateral kidney was measured by the microsphere method. The blood flow of the affected kidney decreased, but was comparable to that of the contralateral kidney immediately after the 1000 shots of SW. Renal scintigraphy using 99mTc-DTPA was performed before the exposure of SW, and 30 minutes, 1 week, 2 weeks and 4 weeks after the exposure. The renograms were evaluated by the following parameters: Tmax (time required to reach maximum radioactivity), RAmax ratio (maximum radioactivity of the affected kidney/that of the contralateral kidney) and T1/2 (the half-life of elimination). Tmax was significantly prolonged for the affected kidney 30 minutes after the exposure, while that for the contralateral kidney was shortened. The RAmax ratio was decreased 1 week after the exposure. T1/2 was significantly prolonged 30 minutes after the exposure, which was observed till 2 weeks later. The scintigraphy also showed a slight enlargement of affected site. The histological study showed a hemorrhage in the peritubular space, indicating rupture of the peritubular capillaries. In conclusion, the main effect of SW exposure on the kidney was the rupture of the peritubular capillaries, resulting in temporary and reversible deterioration of renal function.     

先天性小肾脏单输尿管异位开口的诊断与治疗（附七例报告）

报告７例先天性小肾脏单输尿管异位开口的诊断与治疗。７例均为女性，年龄３．２～１４．０岁，６例异位开口于阴道，１例开口于尿道。Ｂ超、ＩＶＵ均误诊为先天性孤肾，３例作ＣＴ检查仅１例发现囊样变小肾脏，ＣＤＩ检查４例均获确诊，７例均行发育不良肾切除而治愈。对其发病情况、胚胎发生学、诊断与治疗进行了讨论，认为ＣＤＩ是诊断重要手段，对发育不良小肾脏者肾切除为首选治疗。     

How to differentiate between ectopia and displacement in patient with crossed kidney

A patient is described in whom a crossed kidney was found. There was doubt whether this was due to displacement or ectopia of the kidney. A review of literature on this subject gave no answer to our problem. Considering the embryologic development of crossed ectopic kidney and the mechanism of kidney displacement across the midline we found a simple method by which the diagnosis can be made.     

WNK家族基因在小鼠肾脏表达的特性分析

目的检测WNK1和WNK4基因在小鼠肾脏组织中的表达位点。方法RT-PCR方法扩增WNK1和WNK4基因片段作为探针,在小鼠多组织膜上进行Northern印迹杂交。将上述片段克隆入pGEM-T载体,测序证实后,体外转录RNA探针并在小鼠肾脏石蜡组织切片上进行原位杂交。结果WNK1基因广泛表达在小鼠各组织中,在肾脏有9.5kb强杂交信号。WNK4基因主要表达在肾脏组织中,有4.4kb杂交信号。原位杂交显示WNK1基因仅表达在肾脏远曲小管中,而WNK4除表达在肾脏远曲小管外,还表达在髓质集合管上。结论WNK1和WNK4基因均在肾脏中有表达,WNK4基因在肾脏中表达比WNK1基因更广泛。     

Laparoscopic Surgery for Kidney Orthotopic Transplant in the Pig Model

Background and Objectives:

Laparoscopic surgery has rapidly expanded in surgical practice with well-accepted benefits of minimal incision, less analgesia, better cosmetics, and quick recovery. The surgical technique for kidney transplantation has remained unchanged since the first successful kidney transplant in the 1950s. Over the past decade, there were only a few case reports of kidney transplantation by laparoscopic or robotic surgery. Therefore, the aim of this study is to develop a laparoscopic technique for kidney transplantation at the region of the native kidney.

Methods:

After initial development of the laparoscopic technique for kidney transplant in cadaveric pigs, 5 live pigs (Sus scrofa, weighing 45–50 kg) underwent laparoscopic kidney transplant under general anesthesia. First, laparoscopic donor nephrectomy was performed, and then the kidney was perfused and preserved with cold Ross solution. The orthotopic auto-transplant was subsequently performed using the laparoscopic technique. The blood flow of the kidney graft was assessed using Doppler ultrasonography, and urine output was monitored.

Results:

The laparoscopic kidney transplant was successful in 4 live pigs. Immediate urine output was observed in 3 pigs. The blood flow in the kidney was adequate, as determined using Doppler ultrasonography.

Conclusion:

It has been shown that laparoscopic kidney orthotopic transplant is feasible and safe in the pig model. Immediate kidney graft function can be achieved. A further study will be considered to identify the potential surgical morbidity and mortality after recovery in a pig model before translating the technique to clinical human kidney transplantation.     

The survival advantage of pancreas after kidney transplant

Patient survival after pancreas after kidney transplant ( PAK) has been reported to be inferior to patient survival after simultaneous pancreas–kidney transplant (SPK). The authors examine national data to further explore allograft (kidney and pancreas) and patient survival after PAK. Kaplan–Meier and Cox proportional hazard models were used to analyze Organ Procurement and Transplantation Network data from 1995 to 2010. The analysis compared PAK and SPK candidates and recipients. Kaplan–Meier analysis results showed that PAK after either a living or a deceased donor kidney transplant is associated with increased kidney graft survival compared with recipients with type 1 diabetes who received only a kidney. The best kidney allograft survival was for patients who received a living donor kidney followed by PAK. Receiving a living donor kidney was associated with increased pancreas allograft survival compared with receiving a deceased donor kidney. PAK transplant recipients who receive both organs have a survival advantage compared with uremic candidates who receive neither (SPK waitlist). Compared with uremic diabetic waitlist patients, SPK and PAK recipients showed similar overall patient survival. Successful PAK offers a survival advantage compared with receiving neither a kidney nor a pancreas transplant. These data also suggest that receiving a pancreas (after kidney) transplant may have a protective effect on the kidney allograft.     

Acute renal artery thrombosis following blunt trauma.

Forty-one cases of renal artery thrombosis following blunt trauma have been reported previously. Most injuries resulted from acute deceleration, and the left kidney was involved more frequently than the right kidney. An additional case, a nineteen-year-old victim of a motorcycle accident, had immediate surgery following an early diagnosis. Although the kidney was viable, arterial repair was unsuccessful, and a nephrectomy was performed. Following blunt trauma, patients with microhematuria should have an immediate excretory urogram and retrograde cystogram. With nonvisualization of the kidney, arteriography is necessary to establish the diagnosis. Prompt operation is mandatory if the kidney is to be saved.     

The autosomal recessive polycystic kidney disease protein is localized to primary cilia, with concentration in the basal body area

Recent evidence suggests that structural and functional abnormalities of primary cilia in kidney epithelia are associated with mouse and human autosomal dominant polycystic kidney disease. To determine whether fibrocystin/polyductin/tigmin (FPC), the protein product encoded by the PKHD1 gene that is responsible for autosomal recessive polycystic kidney disease among human subjects, is also a component of primary cilia in the kidney, antipeptide antibodies to the carboxyl-terminal intracellular domain and amino-terminal extracellular domain of FPC were generated and were characterized with immunoblotting and immuno-light and -electron microscopy. Immunolocalization in normal kidney tissue sections and cultured kidney cells demonstrated that FPC was localized to the primary cilia and concentrated on the basal bodies in both kidney tissue sections and cultured kidney cells. The FPC expression pattern was not altered in kidney cells with Pkd1 mutations. These findings suggest that FPC is a functional and/or structural component of primary cilia in kidney tubular cells. It is proposed that the pathogenesis of autosomal recessive polycystic kidney disease is linked to the dysfunction of primary cilia.