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Objective To evaluate the predictive values of serum neutrophil gelatinase-associated lipocalin (NGAL), urine NGAL, serum cystatin C (Cys-C) and serum creatinine (Scr) for early delayed graft function (DGF) in kidney transplant recipients. Methods Clinical data, blood and urine samples of 159 kidney transplant recipients were collected. All recipients were divided into the DGF group (n=42) and immediate graft function (IGF) group (n=117) according to the incidence of DGF. Clinical data of all recipients were analyzed. The changes of serum NGAL, urine NGAL, Cys-C and Scr levels were statistically compared between two groups. The predictive values of different markers for early DGF were assessed. Results Among 159 kidney transplant recipients, DGF occurred in 42 cases with an incidence rate of 26.4%. There were statistically significant differences in donor age, cold ischemia time of donor kidney and complement-dependent cytoxicity (CDC) between the two groups(all P < 0.05). Within postoperative 2 weeks, the serum NGAL levels in the DGF group were higher than those in the IGF group (all P < 0.05). The Cys-C, Scr and urine NGAL levels in the DGF group were higher compared with those in the IGF group within 3 weeks after kidney transplantation(all P < 0.001). Serum NGAL, urine NGAL, Cys-C and Scr levels had certain predictive values for early DGF in kidney transplant recipients. Cys-C yielded the highest predictive value with a cut-off value of 4.73 mg/L, sensitivity of 0.833, specificity of 0.812 and area under the curve (AUC) of 0.895. Conclusions Cys-C has higher predictive value for early DGF in kidney transplant recipients compared with serum NGAL, urine NGAL and Scr.
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Objective To investigate the relationship between the interleukin (IL)-35 and the recovery of renal graft function. Methods Clinical data of 45 recipients receiving renal transplantation from donation after cardiac death (DCD) were retrospectively analyzed. According to the presence of delayed graft function (DGF) after renal transplantation, all recipients were divided into the immediate graft function (IGF) group (n=32) and DGF group (n=13). The serum creatinine (Scr) level and estimated glomerular filtration rate (eGFR) in the recipients were statistically compared between two groups at 1, 2, 3, 7, 14, 28 d and 3, 6 and 12 months after renal transplantation. The IL-35 levels in the serum and urine samples of the recipients were statistically compared between two groups at 1, 2, 3, 7, 14, 28 d following renal transplantation. Results In the DGF group, the renal function was restored slowly. Compared with the IGF group, the Scr level was significantly higher, whereas the eGFR was considerably lower in the DGF group at postoperative 7 d (both P<0.05). At 1 year after surgery, there was no significant difference in the Scr level between two groups. Compared with the IGF group, the eGFR in the DGF group was significantly lower at postoperative 1 year (P<0.05). At 1, 2, 3, 7, 14 d after operation, the serum levels of IL-35 in the DGF group were evidently lower than those in the IGF group (all P<0.05). Compared with the IGF group, the serum level of IL-35 in the DGF group was significantly increased at postoperative 28 d (P<0.05). At postoperative 1, 2, 3, 7 d, the IL-35 levels in the urine samples in the DGF group were significantly lower than those in the IGF group (all P<0.05). At postoperative 14 and 28 d, the IL-35 levels in the urine samples did not significantly differ between two groups (both P>0.05). Conclusions The low levels of IL-35 in the serum and urine of recipients after renal transplantation are associated with the incidence of DGF to certain extent, prompting that excessively weak systemic and local anti-inflammatory responses early after renal transplantation and uncontrolled excessive inflammatory response are probably the pivotal causes of DGF.
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Objective To compare the early clinical efficacy of renal transplantation between extended criteria donor (ECD) and standard criteria donor (SCD). Methods Clinical data of 85 recipients undergoing renal transplantation from donation after cardiac death (DCD) were retrospectively analyzed. According to the types of donors, all recipients were divided into the ECD group (n=31) and SCD group (n=54). The level of serum creatinine (Scr), incidence of early complications and clinical prognosis within 3 months after renal transplantation were compared between 2 groups. Results No statistical significance was observed in the levels of Scr within 1 month after renal transplantation between the ECD group and SCD group (all P>0.05). At postoperative 60 and 90 d, the level of Scr in the ECD group was (189±97) and (175± 69) μmol/L respectively, significantly higher than (142±49) and (135±41) μmol/L in the SCD group (P=0.005 and 0.002). In the ECD group and SCD group, the incidence of acute rejection (AR) was 6% and 15%, the incidence of delayed graft function (DGF) was 23% and 19%, the incidence of pulmonary infection was 10% and 6%, the incidence of other early complications was 32% and 15%, respectively, no statistical significance was identified (all P>0.05). In the ECD group and SCD group, the survival rate of the recipient was 97% and 94%, the survival rate of the renal was 84% and 91%, no statistical significance was identified (all P>0.05). Conclusions Compared with the SCD, renal transplantation from ECD can achieve equivalent early clinical efficacy. In the present condition of serious deficiency of donor kidney, the application of ECD can enlarge the supply of the donor kidney.
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Objective To investigate the changesof glomerular filtration rate(eGFR)in type 2 diabetic patients with normal serum creatinine(Scr)and serum cystatin C(Cys-C). Methods A total of 166 patients with type 2 diabetes mellitus admitted into our hospital from January 2014 to September 2015 were enrolled in this study and divided into three groups according to the level of Scr and Cys-C:T2DM patients with normal Scr and Cys-C (normal group,n =109),T2DM patients with normal Scr and high level of Cys-C (high Cys-C group,n=40),and T2DM patients with high levels of Scr and Cys-C (high Scr Cys-C group,n=17). Normal group were further divided into two subgroups according to the level of eGFR:eGFR≥90 ml/(min·1.73 m2 )subgroup and eGFR<90 ml/(min·1.73 m2 )subgroup.Clinical characteristics and laboratory datawere collected in all subjects. eGFR were measured by 99mTc-DTPA nephro-dynamic imaging. Results The average value of eGFR were significantly different in normal group(82.68±13.45)ml/(min·1.73 m2 ),high Cys-C group(67.93 ±14.01)ml/(min·1.73 m2 )and high Scr,Cys-C group (50.54±15.10)ml/(min·1.73 m2 ). In normal group,the proportion of patients with eGFR equal or greater than 90 ml/(min·1.73 m2 )was 26.6%,patients with eGFR ranged from 60 to 89 ml/(min·1.73 m2 )was 72.5%,patients with eGFR ranged from 30 to 59 ml/(min·1.73 m2 )was 0.9%. After follow-up for three months,in normal group,the proportion of patients with CKD stage1 was 4.6%,patients with CKD stage 2 was 34.9%,and patients with CKD stage 3 was 0.9%.Multivariate logistic regressionanalysis in normal group showed that female,older age,higher TC,lower LVEF were risk factors for eGFR decline (P <0.05). Conclusion In T2DM patients with normal Scr and Cys-C, 73.4% of them had mild to moderate eGFR decline,and 40.4%entered CKD stage in this study.eGFR should be evaluated especially in T2DM patients with risk factors including female,older age,higher TC and lower LVEF.
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Glomerular filtration rate (GFR) is the best single measure of overall function of kidney. GFR is routinely assessed by measuring the concentration of endogenous serum markers such as blood urea nitrogen and serum creatinine (SCr). Although widely used these endogenous marker are not ideal and do not perform optimally in certain clinical settings. The purpose of this review is to critically review the potential utility of Cys C as a new promosing markers of GFR and to review whether Cys C had any advantage over routinely used endogenous marker in different population group.