Occurrence and treatment of urological complications following renal transplantation: Data review in 1 223 cases / 中国组织工程研究

BACKGROUND: Urological complication is one of common surgical complications following transplantation and severely threatens renal function, even patient's lives. Urological complications following renal transplantation mainly contain urinary fistula,ureteral obstruction and ureter backflow.OBJECTIVE: To retrospectively analyze the incidence and management of urological complications following kidney transplantation.METHODS: A total of 1 223 patient times following kidney transplants were selected at the Department of Urology, Institute of Surgery Research, Daping Hospital, Third Military Medical University of Chinese PLA from December 1993 to April 2007.According to ureter of donor kidney and the urinary tract of recipients, ureteroneocystostomy was used for urinary tract reconstitution in 948 patient times, and end-to-end ureteroureterostomy in 275 patient times. Urological complications such as urinary fistula, ureteral obstruction and vesicoureteral reflux (VUR) were treated by the different methods on the basis of the different causes, mainly by surgical procedures. Reason of urological complications, surgical management of urologicalcomplications and its clinical outcome, the 3-year survival rate of grafted kidney were measured.RESULTS AND CONCLUSION: In a total of 1 223 patients, urological complications were encountered in 92 cases (7.5%), including 43 cases of urinary fistula (3.5%), 35 ureteral obstruction (2.9%), 14 VUR (1.1%). 35 cases of urinary fistula, 29 ureteral obstruction, 6 VUR were cured by surgical procedures including ureteroureterostomy in 35 patients (50%), revision of ureteroneocystostomy in 18 (25.7%), endourology in 11 (15.7%) and other operation in 6 (9.6%). All recipients with urological complications regained normal graft function except one undoing transplanted nephrectomy due to the pelvis and urteral necrosis. There was no grafted kidney and recipient loss secondary to these complications in the present series. The 3-year survival rate of graft with urological complications and without urological complications did not show significant difference (P > 0.05). These indicated that most of urological complications following kidney transplantation request surgical management, and ureteroureterostomy are frequently used. The long-term graft survival is not affected by a correctly treated urological complication.

Detction of urinary kidney injury molecule-1 for diagnosis of early graft function in kidney transplantation / 中国组织工程研究

BACKGROUND: Urinary kidney injury molecule-1 (KIM-1) has been proved to be a novel kidney-specific injury molecule as a marker for the diagnosis of acute renal ischemia injury, and KIM-1 participated in the progress of renal injury repair. However, no one reported the significance of its dynamic expression during the functional rehabilitation of renal graft.OBJECTIVE: To investigate the relations between urinary KIM-1 level and the early renal graft function in order to provide rational approaches for evaluating or predicting early renal graft function.METHODS: The 46 patients were divided into 3 groups, including 22 cases of immediate graft function (IGF), 14 cases of slow graft function (SGF) and 10 cases of delayed graft function (DGF). The 24-hour urine specimen was collected every day for 2 weeks since the operation. The urinary KIM-1 content was detected by enzyme linked immunosorbent assay (ELISA), and at the same time the urinary and serum creatinine levels were detected. The diversity of urinary KIM-1 level was observed during the recovery of the graft function, and the clinical significance was evaluated by analyzing the correlation of urinary KIM-1 level and serum creatinine.RESULTS AND CONCLUSION: At the first 2 days after kidney transplantation, the urinary KIM-1 levels were high and no significant difference was observed between the three groups (P < 0.05). Two days later, the urinary KIM-1 level descended quickly along with the descent of the serum creatinine in IGF and SGF groups; the urinary KIM-1 maintained high levels until the serum creatinine reached normally. In DGF group, the urinary KIM-1 decreased quickly to a low level after 2 days from operation, but it increased promptly 1 to 2 days before the recovery of graft function and kept a high level until the serum creatinine reached normally. This suggested that consecutive detection of urinary KIM-1 is useful for monitoring the early graft function after kidney transplantation, and high urinary KIM-1 may suggest the recovery of graft function.

Pathogeny of urethral fistula after renal transplantation: A 68-case analysis / 中国组织工程研究

BACKGROUND: Urethral fistula following renal transplantation accounts for 40%-70% of urinary complications, owing to surgical and medical factors. OBJECTIVE: To effectively decrease and avoid attack of urethral fistula after renal transplantation, and prolong the survival of kidney. METHODS: Clinical data from 68 cases following renal transplantation were retrospectively analyzed at the levels of pathogeny, diagnosis and treatment. There were 47 males and 21 females, aging 20 58 years. Urethral fistula occurred at 3 31 days after renal transplantation, and the amount was 60-2 000 mL per day. Based on the principle of the urethral injury classification method, urethral fistula was divided into simple and complex categories, while according to the fistula site, etiology and extent, urethral fistula was divided into low, high and multiple fistula. Attack rate of simple urethral fistula and complex urethral fistula was detected following renal transplantation so as to analyze the pathogeny of urethral fistula. RESULTS AND CONCLUSION: Of 68 cases with urethral fistula following renal transplantation, 47 cases (69.1%) were simple urethral fistula, including 42 cases with ureteral end necrosis, 4 cases with lax anastomotic suture of ureter bladder, and 1 case with ureteral anastomotic badness caused by wound infection, and 21 cases (30.9%) were complex urethral fistula, including 2 cases with renal pelvis fistula, 2 cases with ureter, 11 cases with ureterovesical anastomosis region, 6 cases with ureteral necrosis longer than 2 cm. A lot of causes may induce urethral fistula following renal transplantation. The blood stream, edema, size of fistula, length of the ureter, and operative procedures are selected to ensure free of strain. Urethral fistula can be treated on time on the basis of different situations.

Establishment of standards for classification of urinary fistula after kidney transplantation / 中华泌尿外科杂志

Objective To establish the standards for classification of urinary fistula after kidney transplantation. Methods From December 1993 to February 2009, 1313 cases of renal transplanta-tions were operated, out of which 102 cases of urinary fistulas occurred (7.8%). Based on the princi-ple of the urethral injury classification method, we divide urinary fistula into simple and complex clas-ses by the cause, location, and the severity of the disease. Results There were 81 cases (79.4%) of simple urinary fistulas, of those 76 cases were ureteral end necrosis,4 cases were due to ureter blad-der anastomosis suture,1 case was anastomotic problem caused by wound infection. There were 21 ca-ses(20.6%) of complex urinary fistulas, of these 2 cases had fistulas at renal pelvis, 11 cases at ure-ter-bladder interface and 6 cases had ureteral necrosis longer than 2 cm. For the 81 cases urinary fistu-las patients, 34 patients conservative treatments were cured and 47 patients need surgeries. For all complex urinary fistulas need surgeries: 11 cases had surgery once, 5 cases had 2 times, 3 cases had 3 times and 2 cases had 4 times. Among the 2 groups, three patients (2.9%) died of urinary fistulas which led to severe lung infection. Conclusions A "Five Steps Procedure" could be used for diagno-sis and treatment of post renal transplantation fistula. The urinary fistulas are divided into simple and complex types after renal transplantation. This provides a guidance for the best choice of treatment.

Application of urinary fistula classification standard after renal transplantation: Analysis of 68 cases / 中国组织工程研究

1 313 patients who received renal transplantations at Department of Urology, Research Institute of Field Surgery, Daping Hospital, Third Military Medical University of Chinese PLA from December 1993 to October 2008 were selected in the experiment. Urinary fistula occurred in 68 patients of them after renal transplantation. In order to make diagnosis more standard, 68 patients was classified in accordance with diagnostic classification standards after renal transplantation. The 68 patients were divided into simple and complex urinary fistulas in accordance with lesion degree. They were divided into low, high and multiple fistulas in accordance with the position and etiology. 47 (69.1%) of 68 cases were simple urinary fistulas: 42 cases were because of terminal ureteral necrosis; 4 cases were because the anastomosis was mended unsuitably; 1 case was because of poor healing of anastomosis due to infections. 21(30.9 %) cases were complex urinary fistulas. The position of orificium fistula: orificium fistula located at renal pelvis, ureter and anastomosis were 2, 2 and 11 cases, respectively. 6 cases had ureteral necrosis longer than 2 cm. The times of repair: 11 cases had 1 time, 5 cases had 3 times, 3 cases had 3 times and 2 cases had 4 times. 2 cases (2.9%) died because of severe pulmonary infection caused by urinary fistula. Result suggests that there are two advantages of dividing urinary fistula into the simple and complex types after renal transplantation: one is that the diagnosis of urinary fistula is more carefully and standardized, and the other is that doctors can make the best choice for treatment in order to get the best efficacy.

Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To report our experiences in retroperitoneoscopic renal pedicle lymphatic stripping for chyluria.</p><p><b>METHODS</b>Six cases of filarial chyluria were admitted to our hospital from November 2001 to June 2002. Of these cases, 4 were men and 2 women, with age ranging from 34 to 52 years (mean, 42 years). Diagnosis was made by using urine test for the presence of chyle and fat globule, cystoscopy, excretory urogram and retrograde pyelography. Chyluria was found on the left renal unit in 2 cases and on the right side in 4 cases. The technique of retroperitoneoscopic management of chyluria consisted of nephrolympholysis, hilar vessel stripping and ureterolympholysis.</p><p><b>RESULTS</b>Operative time ranged from 69 to 120 minutes (mean, 95 minutes). Intraoperative blood loss was 50-180 ml (mean, 85 ml). Chyluria disappeared in all patients immediately after operation. Mild hematuria occurred in 4 cases within 12 hours and disappeared at 24 hours. Subcutaneous emphysema around the lesions was found in 2 cases and was spontaneously absorbed 3 days after the treatment. There was no lymphatic leak at the lesions. The patients were discharged from the hospital 5-9 days after the treatment. All patients gained weight and their haemoglobin and serum protein increased by 13.5 g/L and 3.66 g/L respectively. No chyluria recurrence was reported during 1-1.6 years follow-up.</p><p><b>CONCLUSIONS</b>Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is a safe, effective and efficient surgical procedure with minimal invasion, less pain, lower morbidity, short hospital stay and rapid recovery.</p>

Protective effects of curcumin on LPS-induced acute renal injury in mice / 第三军医大学学报

Objective To study the protective effects of curcumin on LPS-induced acute renal injury to offer the clinical evidence of treatment in mice. Methods Fifty-two mice were randomly divided into 3 groups, the control group (n=12), the LPC group (n=20) and the treated group (LPS + curcumin group, n=20). LPS (5 mg/kg) was injected intraperitoneally into the mice of the LPS group. Curcumin (20 mg/kg) was injected intraperitoneally after an intraperitoneal injection of LPS (5 mg/kg) to the mice of the treated group. The TNF-? level of the renal tissue, the serum level of urea nitrogen (BUN) and serum creatinine (Cr) were determined in 3, 6, 12 and 24 h after injection. The expression of TLR2 mRNA was detected with semi-quantitative RT-PCR and the histopathological changes of the kidneys were studied. Results The TNF-? level of renal tissue and the serum levels of BUN and Cr were significantly increased in 3 h after injection in the LPS group and reached the peak at 6 h. The significant increase of the parameters lasted for 24 h. The changes of the expression of TLR2 mRNA were similar to those of TNF-?, BUN and Cr. The histopathological changes of the kidneys included renal tubular necrosis and detachment, formation of casts, glomerular ischemia and shrinkage and infiltration of large amount of PMN in LPS group. In the theated group, the tissue level of TNF-?, the serum levels of BUN and Cr and the expression of TLR2 mRNA were significantly decreased in 3, 6 and 12 h after injection and the histopathological changes were obviously alleviated. Conclusion Curcumin can alleviate LPS-induced acute renal injury and exerts good protection on the functions of the kidneys.

The relationship between gene expression of Toll-like receptor 2 and acute kidney lesion in mice with sepsis / 重庆医科大学学报

Objective:To observe the relationship of the expression of Toll-like 2 receptor(TLR2) with kidney injury in abdominal infection-induced sepsis.Methods:30 mice were randomly divided into 2 groups as follows: cecal ligation puncture group(CLP group,n=15) and sham operation group(control group,n =15).To adopt cecal ligation puncture(CLP) to establish the mice sepsis model,and the expression of TLR2 mRNA and TLR2 protein in kidney tissue were detected by reverse respectively.transcription and polymerase chain reaction(RT-PCR) and Western blo.The TNF?level in the kidney tissue and the creatinine(Cr)in the serum were also measured.Results:The expression of TLR2 mRNA in kidney tissues was markedly upregulated at 6h after CLP,peaked at 12h and kept in high level up to 24h,and the expression change of TLR2 protein was identical with the TLR2 mRNA expression.The expression of TLR2 mRNA was significantly correlated with TNF?and Cr levels.Conclusion:Severe infection could lead to marked up-regulation of TLR2mRNA and its protein expression in kidney tissue.There is a marked correlation between the changes of TLR2 expression and the actue kidney lesion.

Study on CsA Therapeutic Window Concentration in Renal Transplant Recipients / 中国药房

OBJECTIVE:To establish an optimal therapeutic window concentration of CsA trough levels in renal transplant recipients on triple immunosuppressants regimen METHODS:A total 1 874 samples from 268 renal transplant recipients were measured by fluorescence polarization immunoassay(FPIA) According to the duration after operation and clinical diagnoses ,the whole blood CsA trough levels were compared among subgroups RESULTS:The optimal therapeutic window concentration of CsA was 300～400?g/L(within 1 month after operation),250～350?g/L(2nd～3rd month),150～250?g/L(4th～6th month),100～200?g/L(7th～12th month)and 100～150?g/L(more than 12 months) CONCLUSION:The above mentioned therapeutic window concentratin of CsA trough levels was ideal for renal transplant recipients with no marked acute toxic effects and rejection reaction