Embolization of non-tolerated non-functioning kidney graft: Alternative to surgical removal

Abstract The results of treatment by percutaneous transcatheter embolization in eight cases of non-tolerated non-functioning kidney graft are presented. The symptoms resulting from non-tolerance of the renal graft were fever, pain and haematuria. Embolization was well tolerated in all eight cases and the only adverse effect was postembolization self-limited fever in five cases. The symptoms of non-tolerance of the graft disappeared immediately in all cases, with minimal morbidity and no mortality. In only one patient was it necessary to perform second embolization procedure to achieve permanent control of symptoms. We conclude that percutaneous embolization of non-tolerated non-functioning kidney graft is an effective procedure with significantly less morbidity than with surgical graft nephrectomy.     

The quality of life in end stage renal disease care

Abstract The improved prognosis and survival statistics of both renal transplantation and dialysis have focused attention on the quality of life offered by these treatments. Using a standardized questionnaire, we assessed the quality of life of 612 patients undergoing renal replacement therapy at our center. Of these patients, 359 had been transplanted and 253 patients were on dialysis. Concerning the sociodemographic data, only the time on specific treatment was longer in dialysis patients than in transplanted patients (49.2 versus 55.6 months, P < 0.05). Most complaints were more common in dialysis patients than in transplanted patients. Only the side effects of medication were seen more in transplanted patients ( P < 0.005). Life satisfaction was higher in transplanted patients than in dialysis patients. Dialysis patients were more anxious ( P < 0.05) and more depressed ( P < 0.001) than transplanted patients. Transplanted patients also felt that they had more social support than did dialysis patients. Overall life quality was almost equal between patients on hemodialysis and patients on peritoneal dialysis, and between patients on the waiting list for transplantation and those not on the waiting list. Despite a significantly better quality of life after renal transplantation, the percentage of patients working remained unchanged. (57.5% versus 57.8%, P = n.s.). We conclude that despite an improved quality of life after renal transplantation, these patients are economically not more productive than patients on dialysis.     

Renal tubule of dogfish,Scyliorhinus caniculus: A comprehensive study of structure with emphasis on intramembrane particles and immunoreactivity for H+-K+-adenosine triphosphatase

The ultrastructure of renal tubule cells was studied in the European lesser spotted dogfish by the evaluation of thin sections and freeze fracture replicas. Computer-assisted three-dimensional reconstruction of entire nephrons was performed. The distinction of nephron segments and collecting tubule was made using results of previous histological work. The first proximal tubule segment (PI) consists of two subsequent portions, PIa and PIb. PIa is a component of the lateral countercurrent bundle, and PIb, which displays an apical tubulovesicular apparatus and an extended lysosomal compartment, is located in the vicinity of the glomeruli. Rod-shaped intramembrane particles were detected in PIa. The second proximal tubule segment (PII) is a special segment in elasmobranch and teleost fish. PII differs largely from PI in cell morphology and function. The apical cytoplasm was filled with small clear vesicles, and an apical endocytic apparatus was lacking. In the apical cell membrane, rod-shaped particles were revealed by freeze fracture. The apical tight junctions of PI and PII consisted of seven to ten meandering strands. The distal nephron was subdivided into two major segments: early distal tubule (EDT) in the lateral countercurrent bundles and late distal tubule (LDT) in the mesial tissue. The EDT showed marked amplification of basolateral cell membranes. The tight junctions displayed a low number of continuous parallel strands, which is also characteristically found in the diluting segments of other vertebrates. LDT cells showed cytoplasmic studs and rod-shaped intramembraneous particles at the apical cell membrane, thereby resembling type A intercalated cells of collecting duct. The collecting tubule (CT) emerged from the LDT and was part of the countercurrent arrangement inside the lateral bundles. Tight junctions of LDT and CT consisted of many meandering strands in a honeycomb pattern. With immunohistochemistry, binding sites of a polyclonal antibody against an extraplasmic portion of rat gastric H⁺-K⁺-adenosine triphosphatase (ATPase) were observed at the apical cell membrane of PIa, PII, and LDT. From the colocalization of binding sites for the antibody against the transport enzyme with rod-shaped intramembrane particles, we assume that these might be the morphological correlate of gastric H⁺-K⁺-ATPase-like enzyme in the renal tubule. © 1993 Wiley-Liss, Inc.     

Age dependence of tolerance to anoxia and changes in cytosolic calcium in rabbit renal proximal tubules

Calcium(Ca²⁺)-dependent processes mediate, in part, anoxic cell injury. These may account for the difference in sensitivity to anoxia between certain immature and mature renal cells. To address this question, we studied the effects of anoxia on cytosolic free Ca²⁺ concentration ([Ca²⁺]_i), cell integrity, and transport functions in microdissected proximal convoluted tubules (PCT) of <3-week-old (newborn) and >12-week-old (adult) rabbits. Tubules were loaded with 10 μM fura-2 AM by incubation for 60 min at 37°C, and then superfused with isosmotic saline solution gassed with either 95%O₂-5%CO₂ (control group) or 95%N₂-5%CO₂ (anoxia group) for 30 min. [Ca²⁺]_i was measured ratiometrically; cell damage was assessed by nuclear binding of propidium iodide (PI). Anoxia resulted in a fourfold increase in [Ca²⁺]_i in adult tubules (from resting values of 245±10 to 975±100 nM, P <0.001), whereas in newborn tubules the rise was significantly less (from resting values of 137±5 to 165±5 nM, P <0.001 between anoxic groups). Transient exposure to 100 mM potassium chloride, which depolarizes the PCT cells, induced increases in [Ca²⁺]_i from baseline, to 920±90 nM in tubules from adult and to 396±16 nM in those from newborn rabbits (P <0.001 between age groups). After exposure to ligands such as parathyroid hormone (PTH) and ATP, [Ca²⁺]_i increased in both newborn and adult tubules, but to lower levels in newborn tubules. The response to PTH and ATP was transient in both age groups, [Ca²⁺]_i returning to baseline levels after 2 min. Following anoxia, tubules from adult animals exhibited staining of all cell nuclei by 1 min exposure to PI, indicative of gross permeabilization of the cells. Nuclei of anoxic immatures tubules did not stain with PI. The sodium-dependent uptakes of a glucose analogue (¹⁴C-α-methyl-glucopyranoside) and phosphate (³²Pi) were preserved in agarose-filled tubules of newborns after anoxia, whereas in those of adults recovery from anoxia was associated with drastic reduction in the uptake of these solutes. Overall, our results suggest that: (1) during anoxia, cell Ca²⁺ rises to critical levels in PCTs of adults compared with those of <3-week-old animals, (2) Ca²⁺ influx occurs via a pathway activated by exposure to high [K⁺]_o, presumably voltage-sensitive Ca²⁺ channels or reversal of Na⁺-Ca²⁺ exchange, (3) these pathways are either less active or less abundant in proximal tubules of newborn compared with adult rabbits, and (4) secondary active transport activity and cellular integrity are well preserved after anoxia in PCT cells of newborn but not of adult rabbits. Received June 27, 1995; received in revised form December 1, 1995; accepted December 8, 1995     

The flow cytometric detection of alloantibodies in screening for renal transplantation

Flow cytometric screening of sera using pooled chronic lymphocytic leukaemia (CLL) cells has previously been reported as a quick method for detecting HLA antibodies of the IgG class. In this study we investigated the sensitivity of this method in the detection of IgG and IgM alloantibodies, and its performance in serum screening when compared to conventional microlymphocytotoxic screening. Results indicate that flow cytometric screening is more sensitive in the measurement of IgG alloantibodies by up to five doubling dilutions, whereas the converse is true for IgM. IgM autoantibodies were found not to be detectable by flow cytometry. By testing a large number of sera by both methods in parallel, we have found that a significant proportion of sera exhibiting no activity or IgM activity alone on cytotoxic screening contain IgG antibodies detectable with a pool of CLL cells on the flow cytometer.     

Transverse fusion of the renal pelves and single ureter

We present a case of a rare renal anomaly in which the 2 kidneys (separate or fused across the midline) are drained by a common renal pelvis and ureter. Previously reported cases have been reviewed and are classified in 3 groups according to their anatomical features. The lesion is associated with some frequency with imperforate anus, sacral and other vertebral defects, neurogenic bladder, vesicoureteral reflux, upper tract dilatation, and urinary tract infections.     

Prolonged human kidney preservation by intracellular electrolyte flush followed by cold storage

No kidney transplant center responding to a kidney preservation questionnaire would accept a kidney flushed with an intracellular electrolyte solution and cold-stored for over 40 hours. This study from one center is a comparison of 50 primary cadaver kidney grafts preserved with an intracellular electrolyte flush followed by cold storage for 40 to 61 hours to 82 primary cadaver kidney grafts preserved by the same method for 9 to 24 hours. Kidneys cold-stored for over 40 hours had a significantly increased requirement for dialysis in the 1st week following transplantation (82% versus 34%) and a significantly increased 1-month serum creatinine nadir (2.3 mg/dL versus 1.7 mg/dL). Actuarial graft survivals and serum creatinine levels at 1, 2, and 3 years after grafting were not significantly different. Cadaver donor methylprednisolone (30 to 60 mg/kg) two to nine hours prior to kidney removal significantly reduced the requirement for 1st-week hemodialysis in the kidneys cold-stored for over 40 hours (60% versus 91%). Kidneys preserved by flushing with cold intracellular electrolyte solution can be successfully transplanted after over 40 hours of simple cold storage when the warm ischemia time is very short.     

肾细胞癌浸润淋巴细胞的杀伤肿瘤活性测定及表型分析

采用Ｗｈｉｔｅｓｉｄｅ方法从１９例ＲＣＣ中成功地分离到１７例ＴＩＬ，经１９天培养，ＴＩＬ数量平均达１．０４×１０~（１１）个细胞。杀伤自体肿瘤活性为５７．８７±５．８８％，对Ｒａｊｉ细胞的杀伤活性为３７．３９±１０．８８％，两组间比较差异有非常显著性（Ｐ＜０．０１）。明显高于外周血淋巴细胞（ＰＢＬ）的杀伤肿瘤活性（２２．３９±８．８４％）。ＴＩＬ中ＣＤ_３和ＣＤ８细胞分别为６９．９３±６．８０％及４０．２１±６．８０％，均明显高于ＰＢＬ中的ＣＤ３和ＣＤ_８细胞（Ｐ＜０．０１）。ＴＩＬ对Ｋ５６２细胞的杀伤活性为２６．８９±１２．７９％，提示活化的ＴＩＬ有显著的杀伤肿瘤活性，且对自体肿瘤细胞的杀伤活性更为显著，其杀伤活性主要由Ｔ淋巴细胞介导。     

Renal cancer staging: Comparison of contrast-enhanced CT and gadolinium-enhanced fat-suppressed spin-echo and gradient-echo MR imaging

Fifty-three consecutive patients with 61 solid or complex non-fat-containing renal masses compatible with renal cancer were examined with contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging with pre- and postcontrast FLASH (fast low-angle shot) and fat-suppressed spin-echo sequences. CT and MR imaging were performed within a 1-month interval. CT and MR images were prospectively interpreted. Tumor detection and staging were determined in all patients. CT and MR imaging enabled detection of 54 and 58 of 61 renal tumors, respectively. CT and MR imaging showed 34 and 35 of 38 histologically proved renal tumors, respectively, in 31 patients. Tumor size on CT and MR images demonstrated good correlation and correlated well with the size of pathologic specimens of 34 of 38 resected tumors detected with CT and MR imaging (r =.99). Of the 31 tumors in 31 patients who underwent surgical resection, 24 were correctly staged with CT and 29 with MR imaging. CT and MR imaging both enabled correct staging of four of five additional tumors with biopsy proof of tumor stage. A moderate difference in staging was observed between CT and MR imaging (P =.05). CT showed 13 and MR imaging 15 of 15 tumor thrombi. CT and MR imaging both showed 11 of 11 cases of adenopathy. The results suggest that MR imaging is moderately better than CT for the detection and staging of renal cancer.     

Effects of inorganic lead in vitro on ion exchanges and respiratory metabolism of rat kidney cortex

The effects of Pb²⁺ added in vitro to tissue slices, isolated tubules and isolated mitochondria of rat kidney cortex have been studied. Slices were depleted of K⁺ and loaded with Na⁺, Cl⁻ and water by pre-incubation at 1° C, and reversal of these changes was then induced by incubation under metabolically favourable conditions. The net reaccumulation of K⁺ was reduced by a maximum of 30% when Pb²⁺ was present in the medium, the maximal effect being caused by 200 μM Pb²⁺. Lead also caused a reduction of Na⁺ extrusion which was approximately equimolar with its effect on K⁺, but it did not affect the extrusion of Cl⁻ and water. The initial rates of the net, active movements of K⁺ and Na⁺ were not altered by Pb²⁺, divergence from control values only being noted after 15–30 min incubation. The O₂ consumption and the ATP content were 25–30% lower in slices incubated with 200 μM Pb⁺ than in control slices; the effect on ATP content was not observed until incubation had continued for 30 min. In tubules isolated from the renal cortex, the rate of respiration (50%) and ATP content (30%) were also partly reduced by 200 μM Pb²⁺. The consumption of O₂ by mitochondria isolated from the cortex was much more sensitive to Pb²⁺ added in vitro than the respiration of intact cells; the rate of respiration in state 3 (presence of phosphate acceptor) and the respiratory control ratio were drastically reduced, with half-maximal inhibition at 30 and 20 μM Pb²⁺ respectively. Comparison of the effects of Pb²⁺ on energy metabolism and ion transport of the slices with the corresponding effects of antimycin A and ouabain suggests that Pb²⁺ inhibited K⁺ and Na⁺ transport mainly as a consequence of a primary inhibition of the provision of ATP.