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Objective:To explore the influencing factors and guiding significance of troponin I (TnI) increased in patients with renal transplantation.Methods:The clinical data of 195 patients with renal transplantation from December 2019 to June 2021 in Xuanwu Hospital, Capital Medical University were retrospectively analyzed. TnI was routinely detected after surgery, and TnI>0.02 μg/L was abnormal. The incidence of acute coronary syndrome during hospitalization was recorded. Multivariate Logistic regression analysis was used to analyze the independent risk factors of TnI increased after renal transplantation.Results:Among 195 patients with renal transplantation, postoperative TnI increased in 55 cases (28.2%). The age, diabetes complication rate and dialysis time before first renal transplantation in patients with TnI increased were significantly higher than those in patients with TnI normal: (49.2±9.0) years old vs. (41.6±10.6) years old, 27.3% (15/55) vs. 14.3% (20/140) and 24.0 (11.0, 60.0) months vs. 11.0 (4.0, 24.0) months, and there were statistical differences ( P<0.01 or<0.05); there was no statistical difference in hospitalization length of stays ( P>0.05). During hospitalization, acute coronary syndrome occurred in 8 patients (4.1%, 8/195), and 2 patients died. Multivariate Logistic regression analysis result showed that age>50 years old was the independent risk factor of TnI increased after renal transplantation ( OR = 5.11, 95% CI 2.47 to 10.59, P<0.01). Conclusions:The incidence of TnI increased after renal transplantation is high, but the incidence of acute coronary syndrome is not high. The age increases the risk of postoperative TnI increased, but TnI increased does not prolong the hospital stay.
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Objective To investigate the clinical features of renal tumor patients with yon Hip-pel-Lindau (VHL) disease. Methods Clinical data of 9 renal tumor cases with VHL disease were analyzed and reviewed. The renal tumor characteristics were compared with data of 46 sporadic renal cell cancer (SRCC) cases during the same period. Results In the 9 renal tumor cases with VHL dis-ease presented, significant statistical differences were found in the aspects of bilateralness (7 vs 0), ipsilateral multicentricity(5 vs 2)and cystic growth pattern(6 vs 1) compared with SRCC (P＜0.01). During the average follow-up period of 54 months, no significant difference was found in the median survival between VHL disease patients and SRCC patients(136 vs 42 months). However, a better tendency of VHL disease over SRCC was found in survival curve study. Conclusions VHL disease should be considered when renal tumors present bilateral, multicentric or with cystic growth pattern. Management should be individualized with close watchful waiting in combination with nephron sparing surgery. Nephrectomy should be avoided when possible.
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ObJective To discuss the causes,diagnosis,treatment and outcomes of renal artery aneurysm(RAA). Methods Duriog August 1998 and December 2004,1251 patients underwent rehal transplantation,and 5 men(mean age,43)who received end-to-end anastomose from renal graft artery to the internal iliac artery were found to develop RAA.The main complains included aggravated renal function,sudden oliguria or anuria,hypertension and allograft pain.Color Doppler flow and digital subtraction angiography were used to confirm aneurysm.Size of the RAA were 1.8 cm×2.0 cm×2.0 am to 4.0 cm×4.0 cm×5.0 cm. Results Two aneurysms were located at the anastomotic stoma.One patient who lost renal function 1 month after the aneurysm was diagnosed received nephrectomy,regular hemodialysis,and another renal transplantation 1 year later.The other patient successfully underwent cadaver transplantation without removing the original renal allograft after the renal dysfunction occurred.The renal function remained normal during 2 years'follow-up.Two renal artery aneurysm cases also accompanied with proximate renal artery stenosis.One patient was treated with balloon dilatation and stent implantation,and normal renal function was observed during 1 years followup. Another patient had graft removed and underwent retransplantation.The renal function was excellent during 3 years'follow-up.Atherosclerotic plaque within internal iliac artery anastomotic stoma,which lead to artery stenosis and aneurysm,was found in 1 patient.Two days after the renal allograft was removed,this patient died of brainstem embolism. Conclusions End-to-end anastomose from renal graft artery to the internal iliac artery seems to be related with postoperative complications.Patients with confirmed RAA should be cautiously managed.Retransplantation and interventional thera PY may be the choice.
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Objective To evaluate the operative characteristics and efficacy of retroperitoneoscopic resection of renal, ureter and partial bladder for the treatment of native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney.Methods In 5 cases of renal transplantation, there were 2 cases of right native renal pelvic cancer, 1 case of right native renal (pelvic) and ureter cancer and 2 cases of right ureter cancer respectively. The transplanted kidney was in the same iliac fossa side of the tumor. All 5 patients were subjected to nephroureterectomy and bladder cuff excision by retroperitoneoscopic technique.Result Five operations were completed successfully. The operative time was 180 to 280 min, and the blood loss was 50 to 200 ml. The recovery of intestinal function after operation was 12 to 36 h. The urine output was 1 500 to 4 000 per day. Postoperative serum creatinine was still normal. The mean hospital stay after operation was 4.5 days.Conclusion Retroperitoneal laparoscopic nephroureterectomy and bladder cuff excision is a good method to treat the native renal pelvic and ureteral transitional cell cancer occurring at the same side of transplanted kidney. The procedure is safe and less invasive, which provides a good protection of transplanted (kidney).