Transplant renal artery stenosis: Evaluation with contrast-enhanced ultrasound

ObjectiveTo assess the efficacy of contrast-enhanced ultrasound (CEUS) in depicting transplant renal artery stenosis (TRAS).Materials and methodsSeventy-eight patients (56 men and 22 women; aged 36 ± 12.2 years) who were suspected of TRAS due to either Doppler ultrasound (DUS) abnormalities or difficult control of blood pressure and/or persistent deterioration of renal function were enrolled to perform CEUS. The reference standard for the TRAS diagnoses was computed tomography angiography (CTA). The diagnostic performance of DUS and CEUS parameters was assessed by the area under the receiver operating characteristic curve (AUC).ResultsTRAS was diagnosed in 32 out of 78 cases by CTA. The AUC, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CEUS in predicting TRAS were 0.92, 92.3%, 87.5%, 95.7%, 93.3%, and 91.7%, respectively. CEUS rectified 13 (28.3%) false-positive cases on DUS, which were confirmed by CTA. Compared to DUS parameters, CEUS showed the highest AUC, statistically significant differences of AUC were found (P = 0.006–0.039), except for that of the PSV ratio in the main transplant renal artery to that in interlobar artery (PSV-ratio) (AUC: 0.92 versus 0.86, P = 0.422). However, CEUS showed a significantly higher specificity (95.7% versus 76.1%, P = 0.008) and the same sensitivity compared to PSV-ratio.ConclusionsCEUS is superior to DUS in depicting TRAS. Moreover, our results suggest that CEUS might potentially be used as a noninvasive tool to spare many patients from unnecessary CTA.     

Clinically-relevant threshold of preformed donor-specific anti-HLA antibodies in kidney transplantation

BackgroundPretransplant anti-HLA donor-specific antibodies (DSA) are recognized as a risk factor for acute antibody-mediated rejection (AMR) in kidney transplantation. The predictive value of C4d-fixing capability by DSA or of IgG DSA subclasses for acute AMR in the pretransplant setting has been recently studied. In addition DSA strength assessed by mean fluorescence intensity (MFI) may improve risk stratification. We aimed to analyze the relevance of preformed DSA and of DSA MFI values.Methods280 consecutive patients with negative complement-dependent cytotoxicity crossmatches received a kidney transplant between 01/2008 and 03/2014. Sera were screened for the presence of DSA with a solid-phase assays on a Luminex flow analyzer, and the results were correlated with biopsy-proven acute AMR in the first year and survival.ResultsPretransplant anti-HLA antibodies were present in 72 patients (25.7%) and 24 (8.6%) had DSA. There were 46 (16.4%) acute rejection episodes, 32 (11.4%) being cellular and 14 (5.0%) AMR. The incidence of acute AMR was higher in patients with pretransplant DSA (41.7%) than in those without (1.6%) (p < 0.001). The median cumulative MFI (cMFI) of the group DSA+/AMR+ was 5680 vs 2208 in DSA+/AMR− (p = 0.058). With univariate logistic regression a threshold value of 5280 cMFI was predictive for acute AMR. DSA cMFI’s ability to predict AMR was also explored by ROC analysis. AUC was 0.728 and the best threshold was a cMFI of 4340. Importantly pretransplant DSA > 5280 cMFI had a detrimental effect on 5-year graft survival.ConclusionsPreformed DSA cMFI values were clinically-relevant for the prediction of acute AMR and graft survival in kidney transplantation. A threshold of 4300–5300 cMFI was a significant outcome predictor.     

Therapeutic pancreatic endoscopy

Although the common indications for therapeutic pancreatic endoscopy – management of ductal strictures and calculi – have remained constants, the last decade has witnessed the emergence of several new endoscopic techniques for managing pancreatic disorders. While many of the advances in therapeutic pancreatic endoscopy have paralleled the shift of endoscopic ultrasound from a purely diagnostic to therapeutic modality, other new techniques are simply modifications on existing procedures. Despite these exciting times in therapeutic endoscopy, it is important to recognize that the endoscopist is one part of an interdisciplinary team of experts – a model which is essential in the successful management of patients with pancreatic disorders.     

亲属间活体肾移植免疫抑制剂的应用规律

目的:回顾分析150例亲属间活体肾移植的免疫抑制剂应用方案,以总结亲属间活体肾移植患者的免疫抑制剂的应用规律。方法:回顾在我院进行复查并且肾功能稳定的150例亲属间活体肾移植受者免疫抑制剂应用资料,并按照相同染色体倍数分组,同时与同期无关尸体供肾肾移植患者进行比较,并进行统计分析。结果:亲属间活体肾移植受者免疫抑制剂用量与相同染色体倍数相关,两条染色体相同者<一条染色体相同者<无染色体相同者<无关尸体供肾肾移植受者。结论:亲属间活体肾移植受者免疫抑制剂应用量较少,相应的免疫抑制剂相关的不良事件也较少,有利于受者的长期存活。     

Complement—here,there and everywhere,but what about the transplanted organ?

The part of the innate immune system that communicates and effectively primes the adaptive immune system was termed “complement” by Ehrlich to reflect its complementarity to antibodies having previously been described as “alexine” (i.e protective component of serum) by Buchner and Bordet. It has been established that complement is not solely produced systemically but may have origin in different tissues where it can influence organ specific functions that may affect the outcome of transplanted organs. This review looks at the role of complement in particular to kidney transplantation. We look at current literature to determine whether blockade of the peripheral or central compartments of complement production may prevent ischaemic reperfusion injury or rejection in the transplanted organ.We also review new therapeutics that have been developed to inhibit components of the complement cascade with varying degrees of success leading to an increase in our understanding of the multiple triggers of this complex system. In addition, we consider whether biomarkers in this field are effective markers of disease or treatment.     

8例肾移植术后并发淋巴漏患者生长抑素治疗的护理

总结8例肾移植术后并发淋巴漏患者使用生长抑素治疗的护理,认为根据生长抑素的药物性质和肾移植患者的特殊性,做好病情观察和护理,有助于减少用药不良反应的发生,促进淋巴漏的愈合和移植肾肾功能恢复.     

Effect of Oxidation on the Activity of Angiotensin Converting Enzyme in the Rat Kidney,Heart, and Brain

ABSTRACT

The activities of angiotensin converting enzyme(ACE) in crude extracts of renal cortex, heart and brain of the rat were increased when the oxidizing agent diamide was added to the extracts and then the activity determined. By pretreatment of the extracts with 10 mM diamide, the activities of ACE in the extracts of heart, brain and renal cortex were about 500, 290 and 240 % of the control value, determined without the diamide-pretreatment, respectively. In the lung and aorta, increments in the activity after oxidation were less than 20 % of the control. No such increase was observed in the plasma. Similar results were obtained when the extracts were exposed to O₂. The activity was also increased by oxidation with diamide and O₂, when an extract of the human renal cortex was used. Thus, the activity of ACE in the kidney, heart and brain can be increased by oxidation.     

微创经皮肾镜取石术治疗孤立肾肾结石的临床分析

目的探讨微创经皮肾镜取石术(minimally percutaneous nephrolithotripsy,MPNL)治疗孤立肾肾结石的临床经验。方法回顾性分析2006年1月～2010年5月我院MPNL治疗的孤立肾肾结石患者12例的临床资料。结果 12例患者中,10例行一期取石,所有患者均为单通道取石,结石清除率为80%(8/10)。结论 MPNL治疗孤立肾肾结石安全可行,疗效确切,具有创伤小、并发症少,恢复快等优点。