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ObjectiveTo explore the efficacy and safety of percutaneous antegrade stenting in the treatment of ureteral obstruction after renal transplantation.MethodsWe retrospectively reviewed 11patients with renal graft ureteral obstruction (2 cases of acute obstruction and 9 cases of chronic obstruction) from March 2009 to March 2011.The etiology of the obstruction was renal graft-ureter-bladder anastomotic stricture in 5 cases,stone obstruction in 2 cases,and undetermined in 4 cases.Renal graft and collecting system were examined by ultrasonography preoperatively to select suitable puncture position,and then ureteropyelography was performed under X-ray guidance.When the obstruction location was clear,the urology guidewire was implanted to the bladder by needle,and then guidewire was released by cystoscopy.Ureteral stent was implanted along the guidewire,and upper ureteral stents was observed under X-ray. After removal of guidewire,the stent location was confirmed once again.The renal pelvis fistula drainage lasted for 1-2 weeks,and ureteral stent to 6 months to one year.Ultrasound and renal function were tested after 1week,1month,3 months and 6 months,and then every six months.ResultsOperation was done successfully in 10 patients,and failed in one case due to a long segment of ureteral stenosis.The operating time of ureteral stent implantation was 54±27 min.Serum creatinine of patients was reduced from preoperative 326±147 to postoperative 89±49 μmol/L.During a follow-up period of 6 to 27 months,no complications occurred.ConclusionPercutaneous antegrade stenting in the treatment of ureteral obstruction after renal transplantation is safe and effective.
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BACKGROUND: Vasorelaxation plays an important role In the occurrence of cyclosporine A (CsA)-induced nephrotoxlcity.OBJECTIVE: To observe the alleviative effects of green tea polyphenols (GTP) on CsA-induced inhibition of vasorelaxation and the underlying mechanisms.METHODS: Sprague-Dawley rats were randomly and evenly divided into four groups: CsA, control, CsA + GTP, and GTP. After 5 weeks of drug treatment, blood urea nitrogen (BUN) and creatinine (Cre) levels were determined. Then the thoracic aorta rings were mounted on a bath system, and acetylcholine was used to induce vasorelaxation. The effects of L-NAME and indomethacin and the denuded vasorelaxation were evaluated.RESULTS AND CONCLUSION: The BUN and Cre levels in the CsA group were significantly higher than those in the control group (P < 0.05). The maximal response (Emax%) for acetylcholine-induced vasorelaxation in the CsA group was significantly lower than that in the control and GTP groups. After pretreatment with L-NAME, vasorelaxation was significantly lower in the CsA,CsA+GTP and GTP groups than in the control group. After pretreatment with indomethacin, vasorelaxation was significantly higher in the control, CsA +GTP, and GTP groups than in the CsA group. The level of nitric oxide metabolites in the vascular tissue in the CsA group was significantly lower compared with other groups. The results demonstrated that CsA can decrease nitric oxide levels in vascular tissues and induce abnormal endothelium-dependent vasorelaxation, which is mediated by nitric oxide pathway.
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Objective To explore the correlation between post-transplant glomerular filtration rate (GFR) in 1 year and long-term graft survival in renal transplant patients.Methods The clinical data of 334 patients who received their cadaveric kidney transplantations between November 1994 and October 2004 were analyzed retrospectively.According to the GFR at one year after transplant operation, normal GFR group was defined as GFR more than or equal to 1.083 ml/s, while patients whose GFR less than 1.083 ml/s were fallen into abnormal GFR group.Cockeroft-Gault (C-G) formula was used to compare the difference in the renal function between the two groups.Kaplan-Meier assay was used to compare the difference in the allograft survival between the two groups in the functional renal allograft or the non-functional renal allograft.The correlativity of GFR level at the first year and the GFR level at the 5th year was analyzed.Results The GFR level at the first year after transplantation was proportional to the graft survival time of the kidney.Five and ten years after transplantation, the renal transplantation long-term survival rate in the normal renal function groups was significantly higher than in the abnormal renal function groups (P＜0.05).As compared with the GFR level at the first year after transplantation, the changes in amplitude of GFR level at the 5th year after transplantation was (0.080 ±0.248) ml/s, and the descent had a positive correlation with GFR level at the 5th year after transplantatioa Conclusion GFR level at the first year after transplantation predicts long-term renal functioa The higher of GFR level at the first year, the higher of GFR level at the 5th year.
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Objective To evaluate the adjunctive therapeutic effect of intravenous immunoglobulin (IVIG) therapy in the pulmonary infection after kidney transplantation.Methods In 14 cases of pulmonary infection after kidney transplantation, 8 and 6 cases were subjected to high dose (7 to 10 days, group A) or low dose (3 to 7 days, group B) of IVIG therapy besides the standard specific anti-pathogen therapy. In 12 cases of pulmonary infection after kidney transplantation, only standard specific anti-pathogen therapy was given (group C). The incidence and mortality of severe pulmonary infection, levels of serum IgG, IgA, IgM and T lymphocyte subsets among the three groups were observed.Results The incidence of severe pulmonary infection was 0, 66.7 % and 66.7 % respectively in groups A, B and C with the mortality being 0, 16.7 % and 25.0 % respectively. The level of serum IgG was significantly increased in group A after treatment as compared with that before treatment and in group B ( P 0.05 ).Conclusion As an adjunctive therapy, high dose of IVIG at early stage of pulmonary infection can reduce the incidence of severe pulmonary infection and mortality after kidney transplantation.