Vasopressin stimulation of NaCl transport in the medullary thick ascending limb of Henle's loop is decreased in aging mice

The maximal urinary osmolality that can be reached by the kidney is reduced with age. This may be due to impaired NaCl transport by the medullary thick ascending limb of Henle's loop, which is part of the renal concentrating mechanism and is modulated by antidiuretic hormone (ADH). We therefore tested in vitro a possible age-related change in the transport capacity and in the response of this nephron segment to ADH in young (1–2 months) and old (20–24 months) mice. The transepithelial potential difference (V _te) was significantly higher in young mice (+8.5±0.4 mV, n=13) than in old ones (+6.6±0.5 mV, n=17). Addition of 0.1 nmol.l^–1 ADH to the bath solution significantly increased V _te by 5.2±0.5 mV in the young and by 3.1±0.6 mV in the old animals. Application of dibutyryl-cAMP (0.1 mmol.1^–1) did not further increase the hormonal response in both groups. The ADH-mediated increase in the corresponding equivalent short-circuit current (I _SC = V _te/R_te) was twice as great in young mice as in old, indicating that the stimulation of NaCl transport by ADH across the medullary thick ascending limb is significantly reduced with age. These results suggest that the previously reported age-related defect in the urinary concentrating ability of the kidney is partly due to a decreased response of the medullary thick ascending limb to ADH.     

尿流式细胞学在诊断移植肾急性排斥反应中的应用价值

目的：探讨尿流式细胞学在诊断移植肾急性排斥反应中的临床应用价值。方法：对43例肾移植受者的116份尿样本进行尿流式细胞学分析，并将急性排斥组和肾功能稳定组的分析结果进行比较。结果：急性排斥反应组尿淋巴细胞总数以及HLA－DR^ 淋巴细胞数显著增多，与肾功能稳定组比较，P＜0．01，CD8^ 细胞亦增多（P＜0．05），而CD3^ ,CD4^ ,CD19^ 细胞数变化两组差异不显著（P＞0．05），在诊断移植肾急性排斥反应上，HLA－DR阳性样本和淋巴细胞数阳性样本的诊断敏感性和特异性分别达95．2％，90．5％，和92．6％，87．4％，结论：尿流式细胞学分析可反映移植肾内的免疫状态，尿淋巴细胞数的显著增多和尿HLA－DR^ 淋巴细胞增多可以作为诊断急性排斥反应的有意义指标。     

Intraparenchymal fetal striatal transplants and recovery in kainic acid lesioned rats

Striatal kainic acid (KA) lesions induce behavioral and biochemical deficits which resemble symptoms encountered in patients suffering from Huntington's disease. In rats with KA lesions, fetal striatal transplants have shown to reverse the pervasive nocturnal hyperactivity induced by the lesion. In the present study 4.6 mm3 of fetal striatal tissue were delivered bilaterally into the anterodorsal portion of the lesioned caudate nucleus. Care was taken to deliver the transplant within the host parenchyma and away from the lateral ventricles. Locomotor behavior analyzed using the Digiscan animal activity monitors before and after the transplants demonstrated a reversal of the hyperactivity following transplants in 70% of lesioned animals. Microinjections of horseradish peroxidase delivered into the globus pallidus and substantia nigra of a small group of functionally recovered transplanted animals, did not reveal evidence for reinnervation between host nigra or pallidum and the transplant at 10 weeks post-transplantation. Other laboratories have reported anatomical connections by 6 months post-transplantation. Ventricular/brain ratios demonstrated that intraparenchymal transplants significantly reduced the ventricular dilation following KA lesion. These results suggest that functional recovery can be obtained when the transplant is immersed into the host's striatal parenchyma regardless of the existence of long-range anatomical connections.     

腹部器官移植术后并发症的磁共振检查

目的探讨磁共振在腹部器官移植并发症中的诊断价值。方法对4例肝移植、5例胰肾联合移植及2例肾移植患者进行磁共振检查，检查时间在术后28d至2年，采用GE1．5TMR机型，成像技术包括常规平扫及增强扫描。结果4例肝移植，1例发生肝动脉狭窄伴肝坏死，1例发生下腔静脉血栓形成，1例为肝静脉与下腔静脉吻合口明显狭窄，1例为左右肝管明显狭窄；5例胰、肾联合移植中，1例并发急性排斥反应，1例为移植胰慢性排斥反应伴纤维化，1例为迟发性胰腺炎，移植肾4例正常，1例并发急性排斥反应伴肾梗死；2例单纯肾移植者，1例为肾动脉局限性中度狭窄，1例为肾动脉与髂内动脉吻合口处动脉瘤形成。上述病理改变均经组织病理检查和数字减影血管造影证实。结论磁共振可作为腹部器官移植并发症的一种无损伤检查手段，对于血管并发症，有其独有的优势。     

移植肾活检病理和治疗效果117例分析

目的 总结本中心移植肾活检的病理学类型、特点和治疗效果.方法 回顾性分析本院2004年2月～2007年11月共117 例移植肾穿刺活检的病理学资料.根据Banff97 移植肾活检病理学诊断与分类方案,结合患者的病史和临床表现制定相应的治疗策略,并对治疗效果进行随访研究.结果 117例移植肾穿刺活检标本的病理类型为:急性排斥反应共68 例,占58.1%;慢性移植物肾病20 例(17.1%);临界性病变11例(9.4%);CNI药物中毒4例(3.4%);急性肾小管坏死3例(2.6%);其他包括正常和无法确 诊共11例(9.4%).经治疗后,急性肾小管坏死和药物中毒的患者全部好转.11 例临界性病变的患者,治疗有效率为81.8%.慢性移植物肾病的20 例患者,治疗后15 理例(75%)好转.三个时间段急性排斥(O～3 个月、3～12 个月和大于12 个月)的治疗有效率分别为57.1%、41.7%和75%.结论 移植肾穿刺活检为临床治疗提供了可靠的依据.急性排斥仍然是影响移植肾功能的重要因素,并且不同时间段发生的急性排斥治疗效果存在差异.提高对临界性病变的认识并早期治疗可以达到很好的效果.     

血浆置换治疗移植肾复发性FSGS合并大量蛋白尿的远期观察

目的 探讨血浆置换治疗移植肾复发性局灶性节段性肾小球硬化（FSGS）效果及其对远期预后的影响。方法 6例患者首次肾移植后出现大量蛋白尿或／和血肌酐（Cr）升高、并经移植肾活检确诊为FSGS，在不改变免疫抑制方案的情况下，采用血浆置换治疗，观察血浆置换后1年移植肾的病理改变情况，测定血肌酐和24h尿蛋白定量。结果 6例患者中，2例在血浆置换后1年接近完全缓解，4例部分缓解。患者血浆置换后1年，移植肾的肾小球、肾间质、血管及免疫球蛋白病变的等级与血浆置换前相比，差异均无统计学意义。血浆置换后1年及5年的Cr水平与血浆置换前相比，差异均无统计学意义；24h尿蛋白定量与血浆置换前相比，差异均有统计学意义（P〈0．01，P〈0．05）。结论 血浆置换能快速、有效地缓解移植肾复发性FSGS的病变程度和进程，其效果取决于FSGS诊断的及时性，如果已发展到肾小球硬化的程度，血浆置换亦无法将其逆转。     

肾移植患者的多药耐药基因外显子26基因型与术后他克莫司用量的关系

目的研究肾移植患者的多药耐药基因(MDR1)外显子26(exon26)的基因型与术后他克莫司(FK506)用量的关系。方法回顾106例肾移植术后常规使用FK506患者的临床资料。肾移植患者MDR1 exon26基因分型的方法为:提取患者的DNA,采用聚合酶链反应(PCR)扩增MDR1基因,检测限制性内切酶片段的多态性(RFLP)。根据MDR1 exon26基因分型将患者分为CC、CT和TT 3组。检测各组患者肾移植后第3、6和12个月的FK506血药浓度,比较各组患者FK506血药浓度／FK506用量(μg·L-1／mg·kg-1·d-1)的比值及术后1个月内的急性排斥反应发生率。结果受者经MDR1 exon26基因分型示:CC型32例(30．2％),TT型30例(28．3％),CT型44例(41．5％)。CC型患者FK506血药浓度／FK506用量的比值明显低于CT型和TT型(P<0．01),而CT型患者又低于TT型(P<0．05)。CC型患者的排斥反应发生率明显高于CT和TT型(P<0．05),CT与TT型比较,差异无统计学意义(P>0．05)。结论MDR1 exon26 CC型的患者与CT或TT型比较,需服用更高剂量的FK506才能取得与CT或TT型相似的血药浓度。因此,了解患者的MDR1 exon26基因型有利于指导患者肾移植术后个体化用药。     

腹腔镜治疗肾盂旁囊肿10例

目的探讨腹腔镜治疗肾盂旁囊肿的可行性。方法回顾分析2003年10月-2005年3月，10例肾盂旁囊肿行后腹腔镜肾囊肿开窗术。结果10例手术均成功。手术时间40-60min，平均55min。10例随访3～24个月，平均12．8月。无复发。结论腹腔镜治疗肾盂旁囊肿安全、可行。     

Preemptive Retransplantation for BK Virus Nephropathy: Successful Outcome Despite Active Viremia

BK virus nephropathy (BKVN) is now recognized as a major cause of renal allograft loss. Recent reports suggest that retransplantation in patients with graft loss due to BKVN is safe after return to dialysis. Since early transplantation is associated with improved outcomes, it would be advantageous if this procedure could be performed prior to ultimate graft loss. However, little data are available regarding the safety of this approach during active viremia. In this report, we describe successful preemptive retransplantation with simultaneous allograft nephrectomy in two patients with active BKVN and viremia at the time of surgery. With 21- and 12-month follow-up, respectively, both patients have stable allograft function and no evidence for active viral replication. We conclude that preemptive retransplantation can be considered in patients with failing allografts due to BKVN.     

六味地黄冲剂对肾阴虚病人血浆中锌铜含量的影响

肾阴虚病人血浆中锌、铜含量均较正常人血浆中锌,铜含量明显增高(P<0.01)。男女性别间本组未见差异。服用治疗肾阴虚药物六味地黄3种剂型后均使锌,铜含量明显降低(P<0.01),六味地黄冲剂与汤剂效果一致。