Post-transplant kidney from C-III donation after cardiac death of children: a clinicopathologic study of 20 cases / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinical and histopathologic features of post-transplant kidney biopsy tissues from pediatric C-III donors.</p><p><b>METHODS</b>The clinical and pathologic features of 20 cases (22 case-times) of renal transplant biopsies from pediatric cadaveric donors were analyzed by light microscopy and immunohistochemistry according to the Banff system of working classification of renal allograft pathology. Biopsies were compared to those from adult C-III donors and adult cadaveric donors.</p><p><b>RESULTS</b>Sixteen cases (72.7%) showed renal allograft drug toxicity damage by Tacrolimus, seven cases (31.8%) showed degeneration and necrosis of renal tubular epithelial cells, four cases (18.2%) showed T cell-mediated acute rejection and six cases (27.3%) showed renal interstitial inflammation. There were two cases (9.1%) of renal dysplasia and one case (4.5%) of renal infarction. There was insufficient evidence for diagnosis of renal allograft nephropathy. Compared to post-transplant kidney from adult C-III donors, the proportion of drug toxicity damage was higher (P<0.05). Compared to post-transplant kidney from adult cadavers, the proportions of drug toxicity damage, degeneration and necrosis of renal tubular epithelial cells were higher (P<0.05) while the proportion of acute rejection was lower (P<0.05).</p><p><b>CONCLUSIONS</b>The pathologic changes in the post-transplant kidneys from pediatric donors are different from those from adult donors. Optimal long-term outcome can be accomplished by effective treatment based on timely or procedural biopsy.</p>

Related factors of pre-dialysis blood pressure variability in under-age patients undergoing maintenance hemodialysis / 中华肾脏病杂志

Objective To explore the blood pressure variability (BPV) in pediatric patients undergoing maintenance hemodialysis (MHD) and to assess the factors associated with pre-dialysis BPV (pre-HD BPV).Methods The pediatric patients who undergone regular dialysis for more than twelve months from Oct 2005 to Oct 2011 in hemo dialysis center of Guizhou Provincial People's Hospital were divided into high pre-HD BPV group and low pre-HD BPV group.Baseline characteristics,biochemical indexes and cardiac function parameters measured by echocardiography were collected in both groups and multiple linear regression analysis was performed.Results Pediatric patients in high pre-HD BPV group demonstrated significantly higher inter-dialytic weight growth rate (IDWG),pre-dialysis systolic blood pressure and average amount of dehydration than those in low pre-HD BPV group (P ＜ 0.05),while significantly lower hemoglobin and albumin levels than those in low pre-HD BPV group (P ＜ 0.05).Comparison among laboratory indicators,serum phosphorus and parathyroid hormone demonstrated significant difference between groups (P ＜ 0.05).For all pediatric patients,pre-HD BPV was positively correlated with IDWG (β=0.165),pre-dialysis systolicblood pressure (β=0.259),and iPTH (β=0.187),while negatively correlated with hemoglobin level (β=-0.199).Conclusions Increasing IDWG,higher pre-dialysis systolic blood pressure,anemia and secondary hyperparathyroidism influence BPV in pediatric patients on MHD.