Utilization of examining hydrogen ion excretion of renal tubule in antirejection therapy following renal transplantation

Shaoge LIU; Xiangtie LI; Junwen HAO

ABSTRACT

BACKGROUND:

Acute rejection is a main complication and the major risk factors of chronic rejection and chronic graft dysfunction (CGD) after renal transplantation. Therefore, it is significant to investigate the effect of hydrogen ion excretion of renal tubule on the early diagnosis of the dysfunction of graft in renal transplantation patients.

OBJECTIVE:

To explore the effect of the hydrogen ion excretion of renal tubule on the diagnosis and efficacy of acute and chronic rejection of graft after renal transplantation.

DESIGN:

Case-controlled observation.

SETTING:

Department of Urinary Surgery, General Hospital of Jinan Military Area Command of Chinese PLA.

PARTICIPANTS:

A total of 26 patients after successive renal transplantation were enrolled at Department of Urinary Surgery, General Hospital of Jinan Military Area Command of Chinese PLA from May 2000 to June 2005. The age of all patients ranged from 21-58 years with an average of 35 years, including 16 males and 10 females. Recipients' primary diseases were chronic glomerulonephrltis (CGN) and chronic renal function failure (CRF). One patient was in the 2nd transplantation. All patients received cadaveric renal transplantation. Donors and recipients had the same blood type and negative of lymphocytotoxicity test. All patients singed the informed consent.

METHODS:

According to clinical symptoms and bloodstream tested by color Doppler ultrasound, 16 patients without rejection were considered as stabilization group and 10 patients with rejection as rejection group. The rejection group was divided into prerejection, rejection and recovery phases. Medistream urine was collected with clean chemical glass bottle in the morning before operation and at week 1 after operation, once a week for successively 10 weeks. Urine titratable acid, NH+4 and net acidity levels were measured to evaluate hydrogen ion excretion of renal tubule.MAIN OUTCOME

MEASURES:

Urine titratable acid (TA), NH+4 and net acid excretion capacity (NAC) levels of patients in the two groups.

RESULTS:

Totally 26 patients were involved in the result analysis. Hydrogen ion excretion of renal tubule examination showed that the hydrogen ion excretion was intended to normal in rejection prophase patients. The hydrogen ion excretion of renal tubule was significantly decreased in the rejection phase patients, compared with those in the rejection prophase patients and patients of stabilization group (P ＜ 0.01 ). The hydrogen ion excretion of renal tubule was recovered rapidly in the most acute rejective patients after treatment. The recovery of hydrogen ion excretion of renal tubule was various. The recovery time of most cases ranged from 1-10 weeks with an average of about 6 weeks, 2 cases did not recover in 10 weeks and 3 cases of 4 severe rejection cases had slow recovery after treatment.

CONCLUSION:

Hydrogen ion excretion of renal tubule can bridge the gap of bad reflection of renal tubule function from serum creatinine (Scr) and can diagnose the acute rejection after renal transplantation in continuous observation, and especially can be as a valuable index to assess curative effect and prognosis of rejection treatment.