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Objective To investigate the relationship between the ratio of living related donor renal volume (RV) to recipient body surface area (BSA) (RV/BSA) and early postoperative function of transplanted kidney. Methods Clinical data of 120 pairs of donors and recipients undergoing living related renal transplantation were retrospectively analyzed. According to the RV/BSA ratio, the recipients were divided into group A (RV/BSA<65.33 mL/m2), group B (RV/BSA 65.33~76.49 mL/m2), group C (RV/BSA 76.50~96.96 mL/m2) and group D (RV/BSA > 96.96 mL/m2). The postoperative estimated glomerular filtration rate (eGFR) of recipients was compared among 4 groups. The correlation between the RV/BSA and eGFR of recipients at postoperative 6 and 12 months was analyzed. Results The eGFR at postoperative 6 month in group A was significantly lower than that in groups B, C and D (t=2.313, 2.947, 5.903; all P<0.05). The eGFR at postoperative 12 month in group A was also significantly lower than that in groups B, C and D (t=2.189, 2.433, 2.909;all P<0.05). The RV/BSA was significantly correlated with the eGFR of recipients at postoperative 6 and 12 months (all P<0.05).Conclusions RV/BSA is intimately correlated with the early function of transplanted kidney after living related renal transplantation.
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Objective To investigate the clinical efficacy of methylprednisolone intravenous infusion and to take oral prednisone for patients with pulmonary infection after renal transplantation. Methods One hundred and thirty?six patients with severe pulmonary infection after renal transplantation in our hospital from January 2013 to January 2016 were enrolled and randomly divided into 2 groups. All patients were treated with immunosuppressant adjustment based on the basis of routine treatment. Patients in the observation group were applied methylprednisolone, while patients in the control group were applied prednisone. The clinical efficacy between 2 groups were compared. The changes of body temperature, PaO2 during treatment in survivors of both 2 groups and the changes of ACR, Scr, urine β2?macroglobulin after treatment in survivors of both groups were compared. Results There were 2 cases died and 1 case of renal allograft dysfunction in the observation group. There were 2 cases died and 3 case of renal allograft dysfunction in the observation group. No significant difference in clinical efficacy was found between 2 groups (P > 0.05). For survivors, the recovery time of body temperature in the observation group was significantly shorter than that in the control group. From 16 hours until 4 days after treatment, the body temperature in the observation group was significantly lower than that in the control group (P 0.05). Conclusion Methylprednisolone can decrease body temperature and increase PaO2 in patients with pulmonary infection after renal transplantation rapidly, with no effects on reducing the mortality and renal allograft dysfunction, and the middle?time renal function.
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Taking autoimmune inflammation of rheumatoid arthritis as entry point, this paper discussed the clinical effect of horsetail mixture on rheumatoid arthritis [RA] and its mechanism. A total of 60 cases of patients with RA were randomly divided into experimental group and control group using randomized controlled trial. We observed its biochemistry, TNF- alpha and IL-10 before and after treatment, and then systematically assessed the clinical effect of horsetail on RA. Results showed that the total effective rate of experimental group was 80%, while that of control group was 16.67%. After statistical treatment, the differences between two groups were significant [p>0.05]. Comparison of the difference value of TNF-alpha [p<0.05] and IL-0.05 in serum between groups before and after treatment, there were significant differences. Comparison of CRP within group before and after treatment was significant different [p<0.05], while comparison of CRP between groups was not significantly different [p<0.05]. Comparison of ESR and RF within group before and after treatment was significantly different [p<0.01], and comparison of them between groups was also significantly different [p<0.05]. Comparison of difference values within group before and after treatment were also significantly different [p<0.01]. It was concluded that horsetail mixture has remarkable curative effect on rheumatoid arthritis, and its clinical application is safe and reliable. It has obvious down regulatory effect on cell factor TNF- alpha related to RA, that is, it can down regulate the level of pre-inflammatory factor TNF- alpha as well as the level of anti-inflammatory factor IL-10. Therefore, it is considered that the regulating effect of horsetail mixture on TNF- alpha and IL-10 is one of the mechanisms of its treatment on RA
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Objective To explore the characteristics and effects of interventional therapy of transplant renal artery rupture of donation after citizens death (DCD).Method Among 28 cases of DCD renal transplantations (from February 2012 to December 2013),the transplant renal artery rupture occurred in 4 cases.Vascular complications were treated with the guide wires to place stents in the pseudoaneurysms or bleeding period.Result Pseudoaneurysms occurred in 2 cases,and they were successfully discharged after interventional treatment.In the rest two patients,the artery residual ruptured and bled after the nephrectomy,and they recovered after interventional treatment to stop bleeding.Conclusion For kidney transplant recipients,the DCD postoperative infection is risky.Some transplant kidneys have local infection and erosion of renal artery,which causes arterial hemorrhage.The interventional treatment of transplant renal artery pseudoaneurysms and rupture bleeding has the advantages of small trauma and instant effect,and can be used as an alternative treatment of open surgery.
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Objective To analyze the diagnosis and treatment of iliac pseudoaneurysms following renal transplantation.Method The data of two patients with pseudoaneurysm who underwent kidney transplantation were retrospective analysied.Result One case with pseudoaneurysm received transplant nephrectomy,and pathological examination diagnosed mucoraceae infection; the other patient received endovascular treatment and amphotericin B therapy,endly died of hemorrhagic shock.Conclusion The development of pseudoaneurysms at the kidney transplantation recipients with the same donor results in high rates of mucormycosis.They should take anti-fungus therapy and operation as early as possible.
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BACKGROUND:Studies have found that alprostadil can inhibit platelet aggregation, relax vascular smooth muscle, diastole peripheral blood vessels and thereby improving peripheral circulation. OBJECTIVE:To further verify whether alprostadil can promote the early recovery of renal function of renal transplantation recipients. METHODS:Total y 125 patients in the alprostadil group received intravenous infusion of 20μg alprostadil daily, and then compared with the 115 patients in the unused alprostadil group in the same time. The urine volume, serum creatinine and the creatinine clearance were compared between two groups;blood flow resistance-indexes, as wel as the incidences of delay recovery of renal function and acute rejection were detected under color doppler ultrasound. RESULTS AND CONCLUSION:The urine volume and creatinine clearance in the alprostadil group were significantly higher than those in the unused alprostadil group;while the serum creatinine and the blood flow resistance-indexes were lower than the unused alprostadil group. The incidence of delay recovery of renal function in the alprostadil group was 7.2%which was significantly lower than that in the unused alprostadil group (P<0.01);there was no significant difference in the incidence of acute rejection between two groups. The findings suggest that the administration of alprostadil in renal transplantation recipients during the early stage of kidney transplantation can accelerate the recovery of the renal function and can promote the early rehabilitation after renal transplantation.
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Objective To observe the effect of hybrid renal replacement therapy (sustained lowefficiency hemodiafiltration) in recipients with delayed graft function (DGF) after kidney transplantation.Methods In 33 kidney transplant patients with DGF,there were 15 cases subject to sustained low-efficiency hemodiafiltration (SLEDF group),18 cases subject to hemodialysis (HD group).The renal function was tested,and the expression levels of complements C3,C4,and CRP,IL-1β,IL-6,TNF-α were detected before and after therapy.Results In SLEDF group,the renal function recovered in (29 ± 13) days after therapy,and in (47 ± 21) days in HD group.After therapy,the BUN and Scr in both two groups were lower than before (P＜0.01).After therapy,the levels of IL-1β,IL-6 and TNF-α were also lower than before in two groups,and the levels were lower in SLEDF group than in HD group (P＜0.05).The levels of complements C3,C4,and CRP in two groups were decreased after therapy,but there was no statistically significant difference (P＞0.05).Conclusion SLEDF can decrease the level of SCr,BUN and some cytokines in recipients effectively,and It's helpful to recovery of the renal function.SLEDF can be used by DGF recipients in transit time.
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BACKGROUND: Presently, acute rejection following renal transplantation remains a risk factor for chronic rejection and graft function injury, How to non-invasive, rapid and exact diagnosis and prompt treatment is important. OBJECTIVE: To investigate early diagnosis and post-treatment expression of urine monocyte chemoattractant protein-1 (MCP-1) in the acute rejection after renal transplantation, through detecting the association of the urine MCP-1 variation according to some cases of nephridial tissue biopsy. METHODS: We selected 62 chronic renal failure patients who received renal homotransplantations in the Department of Renal Transplantation of Zhengzhou People's Hospital from October 2008 to February 2009. The stable renal function group contained 42 patients with stable renal function following renal transplantation. Acute rejection group contained 20 patients with acute rejection following renal transplantation. We chose 10 patients who examined no abnormalities in the Medical Examination Center of Zhengzhou People's Hospital to detect their urine sample as control group. All patients following renal transplantation underwent conventional immunosuppression. In addition, patients in the acute rejection group were treated with antilymphocyte globulin or methylprednisolone reinforced impact therapy. MCP-1 mass concentration changes were measured by double antibodies sandwich enzyme linked immurosorbent assay. RESULTS AND CONCLUSION: Compared with control group, no significant change was determined in urine MCP-1 mass concentration in the stable renal function group (P > 0.05). The urine MCP-1 mass concentration was significantly increased in the acute rejection group (P< 0.01). Compared with pretreatment, urine MCP-1 mass concentration was significantly decreased following treatment in 20 patients from the acute rejection group (P < 0.01). Of them, 17 cases had relieved clinical symptom, and normal auxiliary examination, and their urine MCP-1 mass concentration was close to the control group; 3 cases were inefficient, whose urine MCP-1 mass concentration was greater than the control group. Eight cases received nephridial tissue biopsy, and kidney pathology demonstrated acute rejection of transplanted kidney, which was similar to urine MCP-1 mass concentration in the acute rejection group prior to treatment (P > 0.05). These indicated that the level of MCP-1 in urine can non-invasively diagnose acute rejection following renal transplantation in an early phase, and monitor therapeutic efficacy. This may be associated with renal pathological injury during acute rejection following renal transplantation.