Reversibility from delayed hyperacute rejection in ABO-incompatible renal transplantation: histopathological findings of renal allograft biopsy.

ABO-incompatible renal transplantation (ABOIRTx) tend to lead to blood type antibody-mediated rejection, the so-called delayed hyperacute rejection (DHAR), which results in short-term graft loss. To clarify the accurate incidence and prognostic value of DHAR among ABOIRTx, we reviewed biopsy specimens obtained from ABOKTx allografts with abrupt dysfunction during the early period after transplantation. Among 74 ABOIRTx patients, 34 patients displayed allograft dysfunction within 14 days following transplantation. The biopsy specimens were classified based on the Banff schema. The pathological diagnosis of ABO blood type antibody-mediated humoral rejection (ABO-AMHR) was made by the following 3 findings: Specimens with all of above-mentioned findings were categorized as severe ABO-AMHR; those with at least one findings, were categorized as mild ABO-AMHR. All patients were treated with steroid pulse therapy and/or modification of other immunosuppressants. Group 1 consisted of severe ABO-AMHR (n = 6); group 2 consisted of mild ABO-AMHR (n = 5); group 3 consisted of acute cellular rejection (n = 3); group 4 consisted of recovery phase of ATN (n = 11); group 5 consisted of calcineurin inhibitor toxicity (n = 2); and group 6 consisted of normal histology (n = 5). One of 6 patients (16%) in group 1 lost the graft because of DHAR irreversible by antirejection and anticoagulation therapy. However, there has been no clear definition of histpathological criteria for DHAR after ABO-incompatible kidney transplantation. The definition must prognosticate whether the rejection process is reversible.

A new method for identifying rigid link models of lower limbs.

A new method for identifying rigid link models of human lower limbs has been proposed in this paper. The method was motivated by necessity of simulating human body movements for rehabilitation or for design of assistive devices. The method is based on combination of random search and least squares estimation techniques. Simulation and experimental results are given to illustrate the effectiveness of the proposed method.

A case of ABO-incompatible renal transplant patient with non-insulin-dependent diabetes mellitus; long-standing observation of serial glomerular change by protocol biopsy.

A 41-yr-old patient with non-insulin-dependent diabetes mellitus (NIDDM), before and after ABO-incompatible renal transplant, is reviewed using serial protocol biopsy. Although she recovered from delayed hyperacute rejection (DHAR) immediately post-transplantation, her graft function deteriorated gradually. A mild acute transplant glomerulitis, noted at the 155th day post-transplantation, progressed to pronounced chronic transplant glomerulopathy over 5 yr. In the specimen of the last biopsy, at 5 yr post-transplantation, glomeruli demonstrated an exudative hyaline lesion, which was characteristic of diabetic nephropathy in addition to chronic transplant glomerulopathy. Therefore, we made a diagnosis of this glomerular lesion as chronic transplant glomerulopathy complicated by diabetic glomerulopathy. Considering the result of this case, the protocol biopsy is a useful procedure to diagnose an accurate cause of graft dysfunction in individual cases. It is concluded that the protocol biopsy is apparently useful for the detection of various pathological processes occurring in allograft and may contribute to a strategy for improvement of graft survival.

[Reflux nephropathy within first year of life. Studies of its clinical features and kidney scar-formation according to treatment modalities].

Clinical data of 106 patients (177 renal units) with vesicoureteral reflux diagnosed within first year of life were reviewed to clarify its clinical feature and reflux nephropathy. 1) 82.1% (87/106) of them were boy, 83.1% (147/177) of renal units had high grade reflux (VUR grade III or more). These findings suggested that some of them were Fetal Vesicoureteral Reflux. 2) At presentation, 57.1% (101/177) of renal units showed renal parenchymal scars and 18.9% (20/106) of cases had renal dysfunction (s-Cr > or = 0.6 mg/dl). Renal dysplasia or hypoplasia was found in rather high incidence of 8.5% (15/177) suggested that normal fetal nephrogenesis is also disturbed in early infants having VUR. 3) The patients having multiple renal scarring bilaterally had significant impaired both tubular and glomerular function, showing reflux nephropathy. 4) During more than 2 years follow-up on 102 renal units, totally 29 of them (28.4%) showed new scar-formation and/or scar-advancement. Among the kidneys more than grade III reflux and undergone antireflux surgery, those with delayed surgery had the incidence of new scar-formation and/or scar-progression as high as 48.6% (18/37). On the other hand, in those with immediate surgery, the incidence was much lower of 14.3% (5/35). In addition, the incidence in case of non-surgery was 38.5% (5/13). Indication or timing of antireflux surgery for infants is still controversial however, the above results suggest that early antireflux surgery which aimed to eliminate reflux and risk of upper urinary tract deterioration from infantile immatured kidney is more beneficial in order to prevent progression of renal scarring and attain normal renal development.(ABSTRACT TRUNCATED AT 250 WORDS)