High-resolution and highly accelerated MRI T2 mapping as a tool to characterise renal tumour subtypes and grades.

BACKGROUND: Clinical imaging tools to probe aggressiveness of renal masses are lacking, and T2-weighted imaging as an integral part of magnetic resonance imaging protocol only provides qualitative information. We developed high-resolution and accelerated T2 mapping methods based on echo merging and using k-t undersampling and reduced flip angles (TEMPURA) and tested their potential to quantify differences between renal tumour subtypes and grades. METHODS: Twenty-four patients with treatment-naïve renal tumours were imaged: seven renal oncocytomas (RO); one eosinophilic/oncocytic renal cell carcinoma; two chromophobe RCCs (chRCC); three papillary RCCs (pRCC); and twelve clear cell RCCs (ccRCC). Median, kurtosis, and skewness of T2 were quantified in tumours and in the normal-adjacent kidney cortex and were compared across renal tumour subtypes and between ccRCC grades. RESULTS: High-resolution TEMPURA depicted the tumour structure at improved resolution compared to conventional T2-weighted imaging. The lowest median T2 values were present in pRCC (high-resolution, 51 ms; accelerated, 45 ms), which was significantly lower than RO (high-resolution; accelerated, p = 0.012) and ccRCC (high-resolution, p = 0.019; accelerated, p = 0.008). ROs showed the lowest kurtosis (high-resolution, 3.4; accelerated, 4.0), suggestive of low intratumoural heterogeneity. Lower T2 values were observed in higher compared to lower grade ccRCCs (grades 2, 3 and 4 on high-resolution, 209 ms, 151 ms, and 106 ms; on accelerated, 172 ms, 160 ms, and 102 ms, respectively), with accelerated TEMPURA showing statistical significance in comparison (p = 0.037). CONCLUSIONS: Both high-resolution and accelerated TEMPURA showed marked potential to quantify differences across renal tumour subtypes and between ccRCC grades. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03741426 . Registered on 13 November 2018. RELEVANCE STATEMENT: The newly developed T2 mapping methods have improved resolution, shorter acquisition times, and promising quantifiable readouts to characterise incidental renal masses.

Systemic autoinflammatory disease, IgA glomerulonephritis and renal cortical necrosis: coincidence or causation?

We present a patient with a rare systemic autoinflammatory disease (mevalonate kinase deficiency -MKD-) with the identification of two heterozygous variants (c.1129G>A and c.32C>T) in the Mevalonate Kinase gene, detected by next generation sequencing and a highly prevalent glomerulonephritis (IgA nephropathy). The patient presents clinically with a monthly recurrent periodic fever from 12 days of age, accompanied by mucocutaneous lesions (maculopapular rash in extremities, aphthous stomatitis), joint (arthralgias in ankles, wrists and knees), lymphoid (cervical lymphadenopathy, splenomegaly), gastrointestinal (diarrhea, abdominal pain) and kidney (hematuria and proteinuria) with repeated biopsies showing IgA nephropathy alternating activity with chronicity. During follow-up. The patients presented a poor therapeutic response to multiple immunosuppressive regimens used for 7 years (corticosteroids, azathioprine, mycophenolate, cyclophosphamide, rituximab and tocilizumab), and finally a good response to canakinumab. Four years after starting canakinumab, during the course of an infection due to a muscle abscess, the clinical presentation is complicated by a severe renal microvascular event (renal cortical necrosis -RCN-) with acute kidney injury and dialysis requirement. Therecurrent episodes of inflammation due to MKD could act as triggers for the reactivation of glomerulonephritis (which would explain the poor response to immunosuppressants and the rapid progression to histological chronicity) and to generate a microenvironment that predisposes the development of RCN in the face of a non-serious infection. A defect in IgA molecules has been described in MKD, a phenomenon also observed in IgA nephropathy. This raises the challenging hypothesis of a common pathogenetic link between all the patient's clinical manifestations.

Presentamos un paciente con una rara enfermedad autoinflamatoria sistémica (deficiencia de mevalonato quinasa -DMQ-) con la identificación de dos variantes heterocigotas (c.1129G>A y c.32C>T) en el gen Mevalonato Quinasa, detectadas por secuenciación masiva en paralelo y una glomerulonefritis de alta prevalencia (nefropatía por IgA). El paciente presentó un cuadro de fiebre periódica recurrente mensual desde los 12 días de vida, acompañada de lesiones mucocutáneas (rash maculopapular en extremidades, estomatitis aftosa), compromiso articular (artralgias en tobillos, muñecas y rodillas), linfoideo (linfoadenopatía cervical, esplenomegalia), gastrointestinal (diarrea, dolor abdominal) y renal (hematuria y proteinuria) con repetidas biospias mostrando nefropatía por IgA alternando actividad y cronicidad. Durante el seguimiento, tuvo una pobre respuesta terapéutica a múltiples esquemas inmunosupresores utilizados durante 7 años (corticoides, azatrioprina, micofenolato, ciclofosfamida, rituximab y tocilizumab), y buena respuesta finalmente a canakinumab. Cuatro años posteriores al inicio de canakinumab, durante el curso de una infección por un absceso muscular, el cuadro clínico se complica con un evento microvascular renal grave (necrosis cortical renal -NCR-) con fallo renal agudo y necesidad de diálisis. Los episodios recurrentes de inflamación por la DMQ podrían actuar como gatillos para la reactivación de su glomerulonefritis (lo que explicaría la escasa respuesta a inmunosupresores y la progresión rápida a cronicidad histológica) y para generar un microambiente que predisponga el desarrollo de una NCR ante una infección no grave. En la DMQ se ha descripto un defecto en las moléculas de IgA, fenómeno también observado en la nefropatía por IgA. Esto plantea la desafiante hipótesis de un vínculo patogénico común entre todas las manifestaciones clínicas del paciente.

Impact of passive smoking on renal vascular morphology

ABSTRACT Objective To determine whether passive smoking causes morphological and structural changes in the arcuate arteries of rats exposed for 7 to 28 days. Methods Wistar rats aged eight weeks and weighing 260g on average were allocated to a Control or a Smoker Group. Groups were further divided into 4 groups containing 5 animals each. Morphological-functional analysis of the right kidneys was carried out after 7 and 28 days of exposure to the smoke of 40 cigarettes per day. Cigarettes were burned at set times using automated cigarette-burning equipment ("Smoking Machine" - SM-MC-01). At the end of each exposure period, the kidneys were dissected and submitted to histological processing for morphological and quantitative analysis. Results Exposure to cigarette smoke for 7 days led to a decrease in inner vascular diameter. Decreased thickness of the vascular tunica media was observed after exposure for 28 days. Increased thickness of the tunica adventitia, increased total vascular wall thickness, increased total vascular diameter and qualitative increase in collagen deposition were observed. Vascular volume increased after 28 days of exposure. Conclusion Passive smoking has a negative impact on renal vasculature.

Asymmetric Opening of Mitochondrial Permeability Transition Pore in Mouse Brain Hemispheres: A Link to the Mitochondrial Calcium Uniporter Complex

Abstract The prolonged entry of large amounts of calcium into the mitochondria through the mitochondrial calcium uniporter complex (MCUC) may cause the permeability transition pore (mPTP) to open, which contributes to the pathogenesis of several diseases. Tissue-specific differences in mPTP opening due to variable expression of MCUC components may contribute to disease outcomes. We designed this study to determine differential mPTP opening in mitochondria isolated from different regions of mouse brain and kidney and to compare it with the expression of MCUC components. mPTP opening was measured using mitochondria isolated from the left/right brain hemispheres (LH/RH, respectively) and from kidney cortex/medulla, while the expression level of MCUC components was assessed from total cellular RNA. Interestingly, LH mitochondria showed less calcium-induced mPTP opening as compared to RH mitochondria at two different calcium concentrations. Conversely, mPTP opening was similar in the renal cortex and renal medulla mitochondria. However, the kidney mitochondria demonstrated bigger and faster mPTP opening as compared to the brain mitochondria. Furthermore, asymmetric mPTP opening in the LH and RH mitochondria was not associated with the expression of MCUC components. In brief, this study demonstrates thus far unreported asymmetric mPTP opening in mouse brain hemispheres that is not associated with the mRNA levels of MCUC components.

Morphofunctional study on the effects of passive smoking in kidneys of rats / Estudo morfofuncional sobre os efeitos do tabagismo passivo em rins de ratos

ABSTRACT Objective To analyze whether passive inhalation of cigarette smoke causes morphological, structural, and functional changes in kidneys of rats. Methods Wistar rats, aged eight weeks, weighing on average 260g, were divided into Control Group and Smoking Group. Each group was subdivided into four groups of ten animals for morphofunctional analysis, in a period of seven and 28 days. The Smoking Group was exposed to smoke of 40 cigarettes per day, at certain times and in automated equipment for cigarette burning, called smoking machine (SM-MC-01). After the exposure period, urine and blood samples were collected for the functional analyses, and the kidneys were dissected and submitted to histological procedures for morphoquantitative analyses. Results After exposure of animals of the Smoking Group, the following were observed: lower weight gain; lower water and feed intake; decreased renal weight, diameter, and volume; reduction in cortical thickness and glomerular volume density; decrease in glomerular and capsular diameter; increase in mesangial density; decreased urine volume; increased levels of glucose, serum creatinine and microalbuminuria; decreased urinary creatinine levels and creatinine clearance rate. Conclusion Passive smoking negatively influences renal morphology and glomerular filtration rate, with effects similar to those described in the literature regarding active smoking.

RESUMO Objetivo Analisar se a inalação passiva da fumaça do cigarro proporciona alterações morfológicas, estruturais e funcionais nos rins de ratos. Métodos Ratos Wistar, com oito semanas de idade, pesando, em média, 260g, foram divididos em Grupo Controle e Grupo Tabagista. Cada grupo foi subdividido em quatro grupos de dez animais para análise morfofuncional, em um período de sete e 28 dias. O Grupo Tabagista foi exposto à fumaça de 40 cigarros por dia, em horários determinados e equipamento automatizado de queima de cigarros, denominado smoking machine (SM-MC-01). Após o período de exposição, foram coletadas amostras de urina e sangue para as análises funcionais, e os rins foram dissecados e submetidos a procedimentos histológicos para análises morfoquantitativas. Resultados Após a exposição dos animais do Grupo Tabagista, observou-se menor ganho de peso; menor consumo de água e ração; menor peso, diâmetro e volume renal; redução em espessura cortical e densidade de volume glomerular; diminuição no diâmetro glomerular e capsular; aumento na densidade mesangial; volume urinário diminuído; níveis aumentados de glicose, creatinina sérica e microalbuminúria; níveis reduzidos de creatinina urinária e redução da taxa de depuração da creatinina. Conclusão O tabagismo passivo influencia negativamente na morfologia renal e na taxa de filtração glomerular, com efeitos semelhantes aos descritos na literatura em relação ao tabagismo ativo.

Energy metabolism changes of renal cortex in a rat model of progressive kidney disease and its mechanisms / 中华肾脏病杂志

Objective To explore the changes of renal cortical energy metabolism and its related molecular mechanisms in rats with progressive kidney disease.Methods A rat model of 5/6 nephrectomy was established as the model of progressive nephropathy.Rats were divided into surgical group (5/6Nx group) and sham-operated group (Sham group).Respectively,the rats were sacrificed at 1 week and 12 weeks after completing the model,and their blood,urine sample and kidney specimens were collected.Blood urea nitrogen,serum creatinine and 24 h urine protein were used to evaluate the renal function.Pathological changes in renal tissue were detected by PAS staining and Sirius red staining.The renal cortical energy metabolites were made quantitative analysis by liquid chromatography-mass spectrometry-based targeted metabolomics.The mRNA expressions of inflammatory cytokines (IL-6,IL-1β),fibrosis factors (fibronectin,collagen-1),glycolytic and tricarboxylic acid (TCA) cycle related enzymes were confirmed by real-time PCR.The protein expressions of fibrotic proteins (fibronectin,collagen-1),silent information regulator 1 (SIRT-1) and liver kinase B1 (LKB1) were tested by Western blotting.Results Compared with those in Sham group,the renal function indexes increased,the renal tissue pathological damage was obvious,the mRNA expressions of renal cortical inflammatory and fibrosis factors increased,and fibrotic proteins also increased in 5/6Nx group rats at 1 week and 12 weeks (all P ＜ 0.05),meanwhile,kidney damage worsened over time.Compared with those in Sham group,in the renal cortex of 5/6Nx group glycolytic metabolite lactate,the TCA cycle metabolites (citrate,isocitrate,oxaloacetate) and the oxidized phosphorylation metabolite reduced coenzyme Ⅰ were up-regulated (all P ＜ 0.05),but adenosine triphosphate (ATP) was no change at 1 week,then the abnormal metabolites increased further at 12 weeks,such as the down-regulation of pyruvate,oxidized coenzyme Ⅰ and ATP (all P ＜ 0.05).The pentose phosphate pathway metabolites (reduction and oxidized coenzyme Ⅱ) shows no statistical significant difference in the two group (all P ＞ 0.05).Compared with those in Sham group,in the 5/6Nx group the mRNA expressions of glycolytic enzyme hexokinase 2 and lactate dehydrogenase a were upregulated in the renal cortex at 1 week,whereas the mRNA expressions of pyruvate dehydrogenase α,pyruvate dehydrogenase β and succinate dehydrogenase of the TCA cycle related enzymes were downregulated (all P ＜ 0.05).Meanwhile,renal abnormal metabolic enzyme mRNA expressions were further increased in the 5/6Nx group at 12 weeks.The protein levels of SIRT-1 and LKB1 were not significantly different in the renal cortex of two group rats at 1 week,while SIRT-1 and LKB1 levels decreased in 5/6Nx group than those in Sham group at 12 weeks (all P＜ 0.05).Conclusions During the progression of nephropathy,rats accompanied with renal fibrosis and inflammatory have energy metabolism changes in the renal cortex which accompanies.The features of metabolic changes are manifested as enhanced glycolysis and decreased oxidative phosphorylation,which is aggravated gradually.Its mechanism is related to the inhibition of energy-regulating proteins LKB1 and SIRT-1.

Preliminary research on renal perfusion in elderly mice assessed by contrast-enhanced ultrasound / 中华老年医学杂志

Objective To explore the characteristics of renal cortical perfusion with contrastenhanced ultrasound (CEU)in elderly mice.Methods Randomly selected 12 healthy C57BL/6J young mice(aged 1-2 months)and 12 healthy elderly mice(aged 18-20 months)were assigned respectively into the control group and the experimental group.All mice were examined by color Doppler ultrasound and CEU.Renal morphology and hemodynamics were assessed with conventional ultrasound and CEU was used to assess renal microvascular perfusion,analyzing the time-intensity curve(TIC) and related parameters,including slope rate of ascending curve (A),area under curve (AUC),peak intensity (PI),and time to peak (TTP).Results Conventional ultrasound showed similar blood flow dynamics in the renal hilum artery,the renal segmental artery and the renal interlobar artery between the young and elderly mice groups(all P ＞0.05).Moreover,CEU showed slower ascendance of TIC in the elderly mice group(P ＜ 0.05).Furthermore,the elderly mice were associated with significantly decreased A (0.74 ± 0.06 vs.0.89 ± 0.12,P ＜ 0.05) and increased AUC (1420.08± 208.30)dB · s vs.(1261.41± 34.65)dB/s(P＜0.05),delayed TTP(7.75 ±0.88)s vs.(6.93± 0.44) s (P ＜ 0.05),and similar PI (P ＞ 0.05),compared with those in the young mice group.Conclusions Qualitative analysis of CEU is capable of detecting renal perfusion differences between young and elderly nice,which might lay a basis for further study.

Clinical value of contrast-enhanced ultrasonography in evaluating renal cortical perfusion in elderly diabetic patients / 中华老年医学杂志

Objective To investigate the clinical value of contrast-enhanced ultrasonography (CEUS)in evaluating renal cortical perfusion in elderly diabetic patients.Methods A retrospective cross-sectional study was conducted.A total of 70 diabetic patients with chronic renal insufficiency stage 1 to 5 were enrolled.The glomerular filtration rate (GFR)was estimated according to the creatinine level.Based on GFR,patients were divided into a mild-to-moderate chronic kidney disease (CKD)group(n=42,CKD stage 1 to 3)and a severe CKD group(n=28,CKD stage 4 to 5).All patients underwent CEUS for the assessment of renal perfusion and renal dynamic imaging for the assessment of GFR.QLAB analysis software was used to obtain the time-intensity curve(TIC)and related parameters including area under the curve(AUC),the ascending slope(A),the derived peak intensity(DP1) and the time to peak (TTP).The differences in renal perfusion parameters were compared between the two groups.Pearson correlation test was used to assess the correlation between the quantitative parameters of renal cortical perfusion and GFR.Results There was no significant difference in age,gender,history of hypertension,basal blood glucose level,systolic or diastolic blood pressure between the two groups (all P ＞ 0.05).CEUS findings revealed high renal cortical blood perfusion in the mild-to-moderate group.There were significant differences in quantitative perfusion parameters including AUC,DPI,A and TTP between the two groups.Pearson correlation test indicated that TTP and A were significantly correlated with GFR in both groups(r =-0.456 and-0.693,0.432 and-0.529,all P＜0.05),while AUC and DPI had no correlation with GFR(r =-0.003 and -0.057,0.066 and-0.081,all P ＞0.05).Conclusions Diabetic patients with mild-to-moderate CKD have high renal cortical blood perfusion.CEUS findings can indirectly reflect renal function.The perfusion parameters A and TTP have good correlations with GFR.CEUS can be used as a safe and effective method to evaluate renal function,especially in patients with severe renal insufficiency,but more studies are needed to verify the results.

Evaluation of Renal Peripheral Inflow Perfusion in Patients with Nephrotic Syndrome by Region of Interest Quantification / 中国医学影像学杂志

Purpose To investigate renal cortical blood perfusion in patients with nephrotic syndrome (NS) by region of interest (ROI) quantification.Materials and Methods Twenty-one patients with NS treated at Wuhan Union Hospital from September 2014 to January 2015 (NS group) and twenty-nine matched healthy subjects (control group) were enrolled in our study.High frequency blood flow dynamic images of the left kidney for all the subjects were acquired by color Doppler (Philips iU22).Resistance index (RI) of interlobar artery,arcuate artery and interlobular artery were measured.Vascularization index (VI),flow index (FI),vascularization flow index (VFI) were further analyzed by ROI quantification at Q-LAB work station.Results ① The signals of renal cortical blood flow in NS patients were sparse and slim;while the signals in the control group were continuous,most of which reached the edge of renal cortical.② No statistical differences of RI values of interlobar artery and interlobular artery were found between the two groups (P＞0.05);③ The renal cortical blood perfusion in the NS patients decreased significantly compared with that in control group,and the renal cortical VI,FI and VFI values in NS group were significantly lower (P＜0.01).④ Bland-Altman analysis showed that there was good repeatability in the measurement of renal cortical VI,FI and VFI.Conclusion Color Doppler flow imaging combined with RO1 quantitative technique can assess renal cortical blood perfusion accurately,which provides diagnostic information for early detection of renal damage.

Tranexamic Acid-Induced Acute Renal Cortical Necrosis in Post-Endoscopic Papillectomy Bleeding

Acute renal failure can be the result of acute renal cortical necrosis (RCN), which commonly occurs from complications occurring during pregnancy. RCN is rarely caused by medications, although tranexamic acid, which is used in patients with acute bleeding for its antifibrinolytic effects, reportedly causes acute RCN in rare cases. An 82-year-old woman experienced gastrointestinal bleeding after endoscopic papillectomy of an ampullary adenoma. The bleeding was controlled with tranexamic acid administration; however, 4 days later, her urine volume decreased and she developed pulmonary edema and dyspnea. Serum creatinine levels increased from 0.8 to 3.9 mg/dL and dialysis was performed. Abdominal pelvic computed tomography with contrast enhancement revealed bilateral RCN with no renal cortex enhancement. Renal dysfunction and oliguria persisted and hemodialysis was continued. Clinicians must be aware that acute RCN can occur after tranexamic acid administration to control bleeding.

Application of time-spatial labeling inversion pulse in renal corticomedullary differentiation and time parameter optimization / 中国医学影像技术

Objective To investigate the application value of time-spatial labeling inversion pulse (T-SLIP) in renal corticomedullary differentiaton and the best black blood inversion time (BBTI) value.Methods Totally 60 volunteers were included,who underwent abdominal MR scan with noncontrast-enhanced SSFP sequence combined with T-SLIP.All subjects were scanned with different BBTI (800,1 000,1 200,1 400,1 600,1 800 ms) using coronary T-SLIP SSFP sequence.The images quality was evaluated using a four-point scale method.The region of renal cortex and medulla was devised automatically based on the image training algorithm.The signal intensity ratio with the different BBTI was calculated through measuring the signal intensity of the renal cortex and medulla.And the best BBTI values were analyzed.Results When BBTI was 1 200 ms,the image score was the highest.The signal intensity ratio (SIR) had statistical difference among different BBTI groups (all P＜0.05),when BBTI was 1 200 ms,the SIR was the highest,and the contrast between the renal cortex and medulla was obvious.Conclusion T-SLIP technology can improve the visibility of renal corticomedullary without contrast agents.The optimal BBTI for the best corticomedullary differentiation is 1 200 ms.

Assessment of the diffusion-weighted imaging for the pathology and renal function in IgA nephropathy / 天津医药

Objective To study the correlation between the diffusion-weighted imaging (DWI) measurements and glomerular filtration rate (GFR), Katafuchi scores in IgA nephropathy. Methods Thirty-five patients with IgA nephropathy (IgAN group) and twenty healthy volunteers (control group) were enrolled in this study. All of the subjects underwent bilateral renal DWI measurements with 3.0T MRI scanner. The values of apparent diffusion coefficient (ADC) of renal cortex and medulla were measured. GFR of IgAN group was detected with 99Tcm-DTPA scintigraphy. Based on the Lee classification and the Katafuchi score system, the pathological grading was carried out in patients of IgAN group. The ADC values were compared between control group and different grades of IgAN group. The correlations between ADC and GFR values were analysed in defferent groups. The correlations between ADC values and Katafuchi scores were analysed in IgAN group. Results The renal cortical ADC values were significantly higher than medulla ADC values in both control group and IgAN group (P 0.05). There was a positive correlation between the renal cortical and medulla ADC values and the GFR values in IgAN group (P medulla ADC values and the Katafuchi scores in IgAN group (P<0.05). Conclusion The diffusion-weighted imaging can reflect the physiological functions of kidney. It was feasible for application DWI in IgA nephropathy, which can be used for assessing the renal filtration function and the pathological damage. However, DWI measurement is not sensitive to early renal disease.

Study of renal cortical perfusion in rabbits by microbubbles-enhanced ultrasound cavitation / 中华医学超声杂志（电子版）

ObjectiveTo explore the change of renal cortical perfusion in rabbits by microbubbles-enhanced ultrasound cavitation.MethodsTotally 20 New Zealand rabbits were randomly divided into four groups, 5 rabbits in each group. SonoVue was injected via the ear vein at a dose of 0.1 ml/kg. The renal perfusion imaging 30 s modeling was made. Under the mode of contrast enhancement, the rabbit kidneys irradiated with different mechanical indexs (MI) were 0.6 (MI 0.6 group) , 0.75 (MI 0.75 group) , 1.1 (MI 1.1 group) and 1.3 (MI 1.3 group) for 60 s, 15 min respectively. After the irradiation and conventional ultrasound contrast was made again, the renal perfusion imaging was mad. The time-intensity curves (TIC) were analyzed obtained from the following parameters: the slope rate of ascending curve (A) , the slope rate of descending curve (α) , area under the curve (AUC) , time to peak (TTP) , and derived peak intensity (DPI) . One-way ANOVA and LSD-t were used to analyze all experimental data.ResultsCompared with the MI 0.6 group, the MI 1.1 group and the MI1.3 group, the A, α were less than MI 0.6 group, the AUC, DPI, TTP were greater than MI 0.6 group, and the differences were statistically signiifcant (MI 1.1 groupvs MI 0.6 group:t=3.13, 5.31, 4.25, 4.53, 5.72, allP<0.05; MI 1.3 groupvs MI 0.6 group:t=3.67, 6.23, 4.47, 5.48, 6.86, allP<0.05). Compared with the MI 0.75 group, the MI 1.1 group and the MI 1.3 group, the α were less than MI 0.75 group, the AUC, DPI, TTP were greater than MI 0.75 group, and the differences were statistically signiifcant (MI 1.1 groupvs MI 0.75 group:t=6.02, 4.36, 4.85, 5.83, allP<0.05; MI 1.3 groupvs MI 0.75 group:t=6.19, 4.51, 5.73, 6.97, allP<0.05); the MI 1.1 group and the MI 1.3 group, the A were less than MI 0.75 group, and the difference were not statistically signiifcant. The MI 1.1 group and the MI 1.3 group, the MI 0.6 and the MI 0.75 group, and the difference were not statistically signiifcant.ConclusionsTo the change of hemodynamic of the rabbits renal cortical perfusion in the microbubbles-enhanced ultrasound cavitation contrast agent can be observed. Along with the mechanical index increased renal cortical perfusion flow stasis and the perfusion on of slowed in rabbit, may cause renal damage, the TIC curve displayed further changes.

Effect of panax notoginseng saponins on renal cortical tubule cell Bax in early stage after renal trauma in rats / 中华创伤杂志

Objective To measure the effect of panax notoginseng saponins (PNS) on renal cortical tubule cell apoptosis and apoptosis-related genes in early stage after renal trauma and to investigate the protective mechanism of PNS for renal trauma.Methods Seventy-eight Wistar rats were divided into trauma group (n =36),trauma + treatment group (treatment group,n =36),normal control group (control group,n =6) according to the random number table.In treatment group,rats received intraperitoneal administration of PNS (70 mg/kg).Instead,substitute of an equal dose of isotonic saline was used for the rats in trauma and normal control groups.Trauma and treatment groups were subdivided at 1,6,12,24,36 and 48 hours posttrauma,with 6 rats per group.The kidney specimens were extracted at each time point to detect Bax expression in the cortex with immunohistochemistry and in situ hybridization histochemistry.Moreover,the positive expression of Bax was compared among groups and its variation regularity with time were detected.Results In trauma group,mRNA transcription of pro-apoptosis gene Bax increased at 12 hours in the superficial cortex,but increased at 1 hour in deep cortex; protein expression of pro-apoptosis factor Bax showed no apparent reduction within 36 hours in the superficial cortex,but evident decrease within 12 hours in the deep cortex.In treatment group,mRNA transcription of pro-apoptosis gene Bax decreased immediately after treatment in the renal cortex and lasted until 48 h; protein expression of pro-apoptosis factor Bax showed unidirectional reduction until 48 h in the renal cortex.Conclusion PNS inhibits cell apoptosis by down-regulating the mRNA and protein expression of Bax.

Measurement of ABO blood group antibody levels using renal cortical tubular epithelial cells of cynomolgus monkey / 中华器官移植杂志

Objective To investigate the possibility of measuring ABO blood group antibody levels using renal cortical tubular epithelial cells (RCTECs) of cynomolgus monkey.Method The primary RCTECs were isolated from cynomolgus monkey kidneys and identified by Western blotting and flow cytometry (FACS).FACS was applied to detect the expression of ABO histo-blood group antigens on RCTECs,the binding of blood group antibodies in human serum to RCTECs,and to compare the difference of measuring ABO blood group antibody levels between using human erythrocytes and RCTECs as target cells.Result The majority of cells derived from the kidney cortex were renal tubular epithelial cells.39.90％-73.80％ of RCTECs were found to express the ABO histoblood group antigens with the capability to bind the human blood group antibodies specifically.The expression level of ABO histo-blood group antigen on RCTECs was not influenced by long-term cryopreservation,and the percentage of B antigen positive cells was 39.90％ before frozen storage and 39.65％ after a 10-month cryopreservation respectively.The normal serum and allergic serum presensitized to synthetic A antigen-keyhole limpet hemocyanin (KLH-A) of cynomolgus monkey were used to compare the abilities of RCTECs and human erythrocytes to detect antibody titers.No agglutination was observed in RCTECs test group.The mean fluorescence intensity (MFI) values of antibody were highest when the dilution fold was lowest (1 ∶ 16) and gradually decreased with increased serum dilution in both serum groups.MFI fell towards baseline value at 1 ∶ 128 dilution in normal serum group while at 1∶8 192 dilution in allergic serum group.Between 1 ∶ 16 and 1∶8 192 dilutions,MFIs of normal serum group were all lower than those of allergic serum.In human red cells test group,obvious agglutination appeared at high concentrations of antibodies,and MFIs reached the peak at 1∶64 dilution in normal serum group and at 1∶32 dilution in allergic serum group,but fluctuated irregularly thereafter.Between 1∶64 and 1∶512 dilutions,MFIs of normal serum group were all higher than those of allergic serum.Data above showed that MFI values in RCTECs group could reflect the levels of blood group antibodies more exactly.Conclusion The RCTECs of cynomolgus monkey express ABO tissue-blood group antigens and would be more suitable to be used to measure ABO blood group antibody levels by FACS.

Blood Oxygen Level Dependent MRI of Normal Kidney and Its Correlation with Physiological Indexes / 天津医药

Objective To explore the characteristics of blood oxygen level dependent (BOLD) magnetic resonance imaging (MRI) in healthy native kidneys. To investigate the relationship between BOLD-MRI and common physiological in-dexes. Methods GE 3.0T MRI scanner and Torsopa phased-array coil were employed to acquire renal coronal T1WI and BOLD image. Ninety patients who were ruled out chronic kidney diseases underwent BOLD-MRI with T2*-spoiled gradient recalled echo (T2*SPGR) sequence. BOLD images were analyzed on R2*map software. Cortical and medullary R2*values were analyzed in bilateral kidneys and in different gender. Different regional R2*values in cortex and medulla were also ana-lyzed. Physiological indices including age, body height and weight, body mass index (BMI), body surface area (BSA), estimat-ed glomerular filtration rate (eGFR) were recorded. Correlation between R2*value and physiological indices were analyzed. Results Bilateral renal cortical R2*values [left (16.56±1.40) Hz and right (16.66±1.28)Hz, respectively] were less than val-ues in medulla [left (28.82±3.71)Hz and right (28.36±3.72)Hz, respectively]. Female and male cortical R2*values [female (16.55±1.30Hz) and male (16.66±1.38)Hz, respectively] were also less than corresponding values in medulla [female (28.46± 3.64) Hz and male (28.70±3.78) Hz, respectively]. In bilateral renal medullary region, R2*values in low pole (27.29±3.05) Hz was less than values in middle (29.32±3.47) Hz and upper pole (29.16±4.21)Hz (F=15.184, P<0.001). Age was positive-ly correlated with R2* values in medulla (r =0.284, P =0.002). However, eGFR was negatively correlated with medullary R2*value (r=-0.232, P=0.007). Conclusion R2*values reflected the levels of renal partial pressure of oxygen and as-sessed the degree of renal ischemia. BOLD MRI could offer a simple, convenient and noninvasive method for to evaluate renal oxygen metabolism in cortex and medulla.

Contrast-enhanced ultrasound in the assessment of renal cortical perfusion in rabbits in low temperature conditions / 中华超声影像学杂志

Objective To explore the value of contrast-enhanced ultrasound(CEUS) in the evaluation of the renal cortical perfusion in rabbits in low temperature conditions.Methods 20 New Zealand rabbits were randomly divided into five groups,4 rabbits in each group:1) with the first group as the control group (under the conditions of room temperature) ; 2)The second group was treated under-15℃--23℃ for 8hours; 3)the third group was treated under-15℃--23℃ for 4 hours; 4)the fourth group was treated under-6℃--14℃ for 8 hours; 5) the fifth group was treated under-6℃--14℃ for 4 hours.SonoVue was injected via the ear vein at a dose of 0.1 ml/kg,the renal perfusion imaging was made,observing the dynamic image of 0-3 min after the injection and analyzing the time-intensity curves(TIC)obtained from the following parameters:the slope rate of ascending curve(A),the slope rate of descending curve(α),area under the curve (AUC),time to peak (TTP),and derived peak intensity(DPI).Results Compared with the control group,the A,α of the second and the fourth group were significantly decreased (P ＜ 0.05),while the AUC was significantly increased (P ＜ 0.05) and the TTP was significantly prolonged(P ＜0.05),for the third and the fifth group,only the A was decreased (P ＜0.05),and the DPI in each group showed no significant difference.Compared with the third and the fourth group,the AUC of the second group was increased and the TTP was prolonged (P ＜0.05).Conclusions Contrast-enhanced ultrasound can reflect the earlier renal cortical hemodynamic changes in rabbits in the low-temperature conditions,and is of great value for the early diagnosis of renal damage caused by low temperature.

A Case of Acute Kidney Cortex Necrosis Caused by Tranexamic-Acid / 대한내과학회지

Kidney cortex necrosis is a relatively rare cause of acute kidney injury and is characterized by complete or partial destruction of the renal cortex, but sparing of the medulla. Tranexamic acid has antifibrinolytic activity and is used to reduce bleeding. We report a rare case of kidney cortex necrosis caused by tranexamic acid. A 49-year-old woman complained of coughing up blood-tinged sputum. She had a history of bronchiectasis and was treated with tranexamic acid for 3 days. Four days after admission, she developed anuria and azotemia. Computerized tomography showed enhancement of the renal medulla, but not the bilateral renal cortex. The patient was treated with hemodialysis, and has since been maintained on hemodialysis for 6 months. Due to the development of kidney cortex necrosis in patients treated with tranexamic acid, all its potential complications should be considered.

A Case of Acute Kidney Cortex Necrosis Caused by Tranexamic-Acid / 대한내과학회지

Kidney cortex necrosis is a relatively rare cause of acute kidney injury and is characterized by complete or partial destruction of the renal cortex, but sparing of the medulla. Tranexamic acid has antifibrinolytic activity and is used to reduce bleeding. We report a rare case of kidney cortex necrosis caused by tranexamic acid. A 49-year-old woman complained of coughing up blood-tinged sputum. She had a history of bronchiectasis and was treated with tranexamic acid for 3 days. Four days after admission, she developed anuria and azotemia. Computerized tomography showed enhancement of the renal medulla, but not the bilateral renal cortex. The patient was treated with hemodialysis, and has since been maintained on hemodialysis for 6 months. Due to the development of kidney cortex necrosis in patients treated with tranexamic acid, all its potential complications should be considered.

A Case of Bilateral Acute Renal Cortical Necrosis Complicated by Tranexamic Acid Administration / 대한내과학회지

Acute renal cortical necrosis is an anuric form of acute renal failure. We experienced a case of renal cortical necrosis complicated by tranexamic acid administration. To our knowledge, only three cases of renal cortical necrosis have been reported worldwide. A 49-year-old man was referred with hemothorax and multiple bone fractures following a traffic accident. Tranexamic acid, and hemocoagulase were injected three times a day. After the 4th dose of hemostatics, anuria developed abruptly, the platelet count decreased to 84,000 /microL, and the serum creatinine was increased to 2.56 from 1.06 mg/dL. On the 4th Intensive Care Unit (ICU) day, computed tomography (CT) showed bilateral renal cortical necrosis with normal renal arteries and aorta. The oliguria persisted for 14 days and temporary hemodialysis was performed. The serum creatinine had decreased to 2.12 mg/dL 8 months after discharge.