Histopathology of a human allografted kidney with clinically sufficient function.

To clarify the clinico-pathological significance of protocol biopsy and clinically silent rejection in the management of renal graft recipients, we selected a total of 139 (23%) from 604 biopsy specimens according to the following criteria: 1) less than 1.4 mg/dL of serum creatinine and 2) more than 1,500 mL/d of urine volume at time of biopsy. Clinical indications for the biopsy were classified into five categories: i) protocol biopsy (73 specimens), including 69 cases at discharge post-transplantation; ii) slight increase in serum creatinine (32); iii) proteinuria (20); iv) evaluation of pulse-therapy (13); and v) fever elevation (1). Except for the last category, the specimens were histopathologically diagnosed as being normal in 50 (68%), 6 (17%), 1 (5%), and 5 (38%) specimens, respectively. Even borderline changes, and mild acute rejection, as well as drug-induced nephropathy were included, implying the existence of clinically silent rejection or drug-induced nephropathy. Obvious diversity in the histopathological diagnosis was noted in category iii) showing proteinuria, which was mainly caused by chronic rejection, drug-induced nephropathy and glomerulonephritis. The graft survival rate was no different among the four categories, except for category v). These results indicate that biopsies obtained from functionally sufficient renal grafts could provide useful information in the management of the recipients. The clinical significance of protocol biopsy awaits further clarification by the analysis of a large number of cases.

TT virus infection among renal transplant recipients.

To clarify the prevalence of TT virus (TTV) infection in renal transplant recipients and to estimate the role of TTV in patients with post-transplant liver function abnormalities, TTV-DNA of 47 renal transplant recipients was screened by polymerase chain reaction (PCR) according to a method described by Okamoto et al. before and after the renal transplantation. One of them was positive for hepatitis B surface antigen (HBsAg), one was positive for anti-hepatitis C virus (HCV) and other 45 were negative for both HBsAg and anti-HCV. TTV-DNA was detected in 22 of 47 patients before renal transplantation, and nine became positive after transplantation. All 47 patients showed a normal level of ALT before transplantation. Three of nine (33%) who became positive for TTV-DNA after transplantation and three of 16 (19%) who were negative for TTV-DNA before and after transplantation showed transient elevation of ALT. These results indicate that TTV was highly prevalent among renal transplant recipients, but a clear association between TTV and post-transplant liver function abnormality was not found.

Expression of growth factors after the release of ureteral obstruction in the rat kidney.

BACKGROUND: Little is known about the mechanisms underlying recovery from hydronephrosis. Using a rat kidney model, we investigated the possible contribution of growth factors during regeneration after hydronephrosis. METHODS: After the unilateral ureteral obstruction for 7 days, the obstruction was released by ureterocystostomy. Epidermal growth factor (EGF), hepatocyte growth factor (HGF) and transforming growth factor-beta1 (TGF-beta1) were studied using immunohistochemistry and semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: The immunoreaction of EGF in the medulla of both obstructed and contralateral kidneys increased after releasing the obstruction. The release of ureteral obstruction brought further increased immunoreaction of HGF to both the cortex and the medulla of the contralateral kidney. The immunoreaction of TGF-beta1 also increased in the interstitium especially around the blood vessels in the post-obstructed kidney. The expression of HGF and EGF mRNA in both kidneys and TGF-beta1 mRNA in the obstructed kidney were increased after releasing the obstruction. CONCLUSIONS: These results suggest that various growth factors may be involved in the post-obstructive tubular recovery and interstitial damage in the rat kidney.

Long-term visual recovery after scleral buckling for macula-off retinal detachments.

The authors retrospectively investigated the long-term visual recovery in 32 macular reattached eyes that had been monitored for more than 5 years after surgery. The best corrected visual acuities were better at 5 years postoperatively than at 3 months by two lines or more in 17 eyes (53%). In these 17 eyes, visual acuities continued to improve for up to 10 years after surgery. In the other 15 eyes, the visual acuities remained within one line of the 3-month values. Improvement of the long-term postoperative visual acuity was found to be statistically correlated with younger age, no or mild myopia (>-5 diopters), and shorter duration of macular detachment (< or =30 days). Surgeons should be aware that the visual function of reattached retinas may continue to improve over the long term, especially when these beneficial factors are present.

[The mechanism of corneal epithelial disorder induced by prostaglandin F2 alpha isopropyl unoprostone].

Deleterious effects of isopropyl unoprostone (PG-F2 alpha) on the ocular surface were evaluated using the in vivo barrier function assay of corneal epithelial cells and the proliferation assay of human corneal epithelial cells in vitro. The barrier function of corneal epithelial cells in vivo was not impaired by treatment with PGF2 alpha, but it was significantly suppressed by timolol. The result of cell proliferation assay of human corneal cells showed that the 0.12% PGF2 alpha ophthalmic solution caused greater suppression of cell proliferation and acuter cell toxicity than 0.5% timolol ophthalmic solution. Further study showed that not the vehicle but the PGF2 alpha itself was responsible for these deleterious effects. We conclude that the 0.12% PGF2 alpha ophthalmic solution affects cell migration and proliferation but not the barrier effects of the ocular surface. These results suggest that the corneal epithelial defect of glaucoma patients may be caused by these two independent mechanisms, namely suppression of cell proliferation by PGF2 alpha and the destruction of the barrier function of the ocular surface by timolol.

[Long-term visual recovery after scleral buckling of macula-off retinal detachments].

We retrospectively investigated long-term visual recovery in 32 macular reattached eyes which had been followed up for more than five years after surgery. In 17 eyes (53%), the best-corrected visual acuity at 5 years after surgery was > or = 2 lines better than best-corrected visual acuity at 3 months postoperatively. For these 17 eyes, the mean visual acuity continued to improve for up to 10 years after surgery. In the other 15 eyes, visual acuity changes were within 1 line. Improvement of long-term postoperative visual acuity was found to be statistically correlated with younger age, no or mild myopia (< -5D) and shorter duration of macular detachment (< or = 30 days). Surgeons should be aware that the visual function of reattached retinas may recover in the long-term, especially in eyes with these features.

Ex vivo surgery for renal artery aneurysms.

BACKGROUND: Renal artery aneurysms (RAAs), once considered rare, are being recognized with increasing frequency. The treatment of aneurysms of the first ramification of the main renal artery is still controversial. METHODS: From November 1984 to May 1992, we treated 8 patients with RAA at the first ramification. All the patients were treated with an ex vivo technique and autotransplantation. RESULTS: The results, evaluated with intravenous pyelogram and arteriography were satisfactory. No operative deaths and no complications were noted. CONCLUSION: We concluded that surgery with an ex vivo technique and autotransplantation is an excellent method of treating this type of lesion.