[Evaluation of the renal replacement therapy on the liver transplant patients with acute renal failure].

OBJECTIVE: To analyze the preoperative risk factors on liver transplant recipients with acute renal failure(ARF), and to evaluate renal replacement therapy (RRT) as a transitonary therapy before liver transplantation. METHODS: Liver transplant recipients with acute renal failure treated with renal replacement therapy between January 1st, 2001 and January 1st, 2008 in our center were retrospected. Clinical characteristics, the kinds of RRT and prognosis were analyzed; Logistic regression was applied to analyze the parameters that can forecast the motality of the liver transplant recipients with acute renal failure. RESULTS: Of the patients who received RRT, 30% survived to liver transplantation, 67.5% died while waiting for liver transplantation. The dead had a higher multiple organ dysfunction score (MODS), and lower mean arterial pressure than those survived to liver transplantation. There was no significant difference in the duration of RRT between continuous renal replacement therapy (CRRT) patients and hemodialysis patients. CRRT patients had a higher MODS, lower mean arterial pressure, lower serum creatinine than hemodialysis patients. Lower mean arterial pressure was statistically associated with higher risk of mortality. CONCLUSION: Though mortality was high, RRT helps part (30%) of patients survive to liver transplantation. Therefore, considering the high mortality without transplantation, RRT is acceptable for liver transplant recipients with ARF.

[Roles of endothelin and nitrogen monoxide in the adenine-induced acute renal failure models].

OBJECTIVE: To determine the roles of endothelin (ET) and nitrogen monoxide (NO) in the adenine-induced acute renal failure (ARF) models. METHODS: ARF models were established by feeding adenine in rats. The activity of NO synthase (NOS) in kidneys of rats was tested by NADPH-diaphorase. Expression of endothelin-1 (ET-1) in kidneys of rats was studied by immunoreactivity method. The area densities for ET-1 and NOS expressions in kidneys were determined by CMM3 pathology image analysis system to calculate the mean light density. RESULTS: Expressions of ET-1 in normal rat kidneys were wide and weak, but they were greatly enhanced in medulla renis of the ARF models while remained unchanged in the cortex. The activities of NOS were stronger in the cortex and the inner medulla than in the outer medulla. The renal functions of the ARF models were improved after they were treated with L-argine, but the expressions of ET-1 and NOS were not improved. After the withdrawal of adenine, the ARF model rats recovered gradually in their renal functions, and the same was true for the expressions of ET-1 and NOS. CONCLUSION: ET-1 and NO both play important roles in the occurrence, development and recovery of ARF. It is supposed that L-Arg can partly protect the renal functions of ARF rats.