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.

Objective To summarize the characteristics of blunt renal injury in children and re-port experiences in its diagnosis and treatment. Methods A comparison was done on medical data of 30 children and 36 adults with blunt renal injury. The renal injuries were classified according to the organ inju-ry scaling committee of the American Association for the Surgery of Trauma. Results The rate of severe renal injury in the children group was 50%, significantly higher than 31% in the adult group(P<0.05).Surgical exploration rate in the children group was 40%, lower than 73% in the adult group(P<0.05).In the meantime, the kidney conservation rate of 93% in children group was higher than 64% in adult group(P<0.01). Conclusions The kidney of children is susceptible to severe injury but has sound serf-repairing capability. Therefore, surgical interventions and nephrectomy should be considered cautiously.

Objective To summarize the experience on clinical kidney transplantation.Methods 1 053 cases of kidney transplantation were analyzed retrospectively. Factors such as donors conditions, surgical procedure, complications, immunosuppressive therapy, HLA match, and so on were analyzed. Results The 1 , 3 , 5 year survival rate (%) of patient/kidney was 69.3 / 69.0 , 43.0 / 42.6 and 30.7 / 27.8 respectively with the immunosuppressive regime of Aza and Pred before 1988. With the application of CsA after 1989 the survival rate (%) was 93.2 / 92.4 , 79.3 / 78.2 and 66.2 / 64.2 respectively. Acute rejection was the main early complication, 8 % of which could be reversed by prompt therapy. Chronic graft dysfunction was the main complication in the late period, and the main reason for patients' death.Conclusion Good donors conditions and HLA match, reasonable immunosuppressive regime, prevention and prompt therapy of complication after transplantation will improve the patient/kidney survival rate.

Objective To investigation the hydrogen ion excretion of renal tubule in 26 renal transplantation patients for 10 weeks after operation.Methods The medistream urine pH,HCO_3~-,NH_4~+ and titration acid(TA) in 26 cases of renal transplant recipients were detected before and consecutively 10 weeks after renal transplantation,and the net acid content(NAC) was calculated.Results The function of renal tubule was recovered soon but unsteadily in the early stage after transplantation, and tended to be stable after 6 weeks.The levels of TA,NH_4~+ and NAC were significantly lower in 15 cases of acute rejections episodes.The levels were increased quickly in recipients with mild rejection and good therapeutic efficacy to steroids,but slowly in those with severe rejection,requirement of anti-thymic lymphocyte globulin(ATG) or resistant to steroids.Conclusion The function of hydrogen ion excretion of renal tubule may be a better parameter than serum creatinine in reflecting the renal tubule function.It will be useful in the diagnosis of acute rejection during the consecutive observation,especially in the judgement of antirejection therapy and evaluation of prognosis.

Objective To investigate the clinical application of 99mTc-DTPA renography in evaluating the glomerular filtration rate (GFR) in living donor kidney transplantation and to assess the dependence of GFR on age and gender in living kidney donors. Methods There were 212 consecutive potential donors in the study. The potential donor evaluation process included as follows: general health status, liver and kidney ultrasound, hepatitis virus infection and HLA-DR matching. If the results met the general requirements for the donor selection criteria, the GFR was measured using the 99mTc-IDTPA renography according to standard procedure (gates method). The GFR ≥ 1.33 ml/s was considered normal, ＜ 1.17 ml/s was defined as the lower limit for donor GFR, and 1.17 ml/s ≤GFR ＜ 1.33 ml/s further underwent measurement of creatinine clearance (CCr). If the CCr was normal, the GFR was considered normal, and otherwise, potential donors gave up kidney donation.All the donors meeting the donor selection criteria were divided into four age groups. On the other hand, the total donors were divided into the groups aged ＞ 55 years and aged ≤ 55 years. The impact of gender and age on GFR was evaluated preoperation due to age-related changes and gender using Kendall's tau-b correlation coefficient. Results In 212 potential donors, 137 cases had a GFR ≥ 1.33ml/s, 55 cases 1.17 ml/s ≤ GFR ＜ 1.33 ml/s and 20 cases GFR ＜ 1.17 ml/s. Thirty-one cases of potential donors with 1.17 ml/s ≤ GFR ＜ 1.33 ml/s gave up kidney donation due to abnormal CCr or other security considerations. 161 (56 females, 105 males) were qualified as successful donors, and the donor age was 42. 91 ± 11.90 years (range 20 to 62 years). The preoperative total GFR (ml/s) in living kidney donors was calculated as 1.51 ± 0.22 for males, it was 1.45 ± 0.18 for females respectively (P＞0.05). Among the four age groups, there was no significant difference in GFR (P＞0.05). The GFR in the donors aged ＞ 55 years and aged ≤ 55 years was 1.48 ± 0.22 and 1.49 ±0.17 respectively (P＞0.05). Correlation analysis revealed that the GFR in all the donors was not related with age (r = -0. 033, P = 0. 69). Also, there was no correlation between age and GFR in men and women(r= -0.053, P=0.571; r= -0.019, P=0.754). Conclusion 99mTc-DTPA renography is reliable and reproducible for the determination of GFR in living kidney donors. In view of acute donor shortage and if properly screened, kidneys with 1.17 ml/s≤ GFR ＜ 1.33 ml/s can be used without increasing the risk to donor. The GFR is not correlated with the age and gender.

Objective To summarize the clinical characteristics,diagnosis and treatment of malignant tumor after renal transplantation.Methods The clinical data of 2106 renal transplants in 1945 patients undertaken in our hospital from September 1978 to December 2009 was retrospectively studied.Results Of these 1945 patients, 39 cases were diagnosed as having malignant tumor (incidence: 2.0 ％).The interval between transplantation and clinical diagnosis ranged from 8 to 124 months with a median of 57.0 months.Among the 39 cases of malignancy, there were 22 urinary system carcinomas, 8 digestive system carcinomas,2 lung cancers,2 breast cancers,2 lymphomas,1 dura small cell carcinoma,1 pleura poorly differentiated carcinoma and 1 metastatic carcinoma of liver with unknown primary tumor. Surgery was conducted in 28 patients,of which 16 were survived but the other 12 patients died of metastasis ranged from 3 months to 96 months (median,33 months) after operation.11 cases without operation died within from 3 d to 36 months (median,5 months) after diagnosis.Conclusions The incidence of malignant tumors in renal transplant recipients increased markedly.The most common type of the malignant tumors is urinary system carcinoma.The key measure of success in treating malignancy after renal transplantation is early diagnosis and surgical resection.

Objective To analyze the epidemiographic features of urological de novo malignant tumor in kidney transplant recipients in the General Hospital of Jinan Military Command.Methods The clinical data of 1945 patients who received kidney transplantation between September 1978 and December 2009 were retrospectively studied.Among 1945 recipients,22 cases were diagnosed as having urological de novo malignant tumors ( incidence:1.13％ ),including renal papillary adencaicinoma (n =1 ),papillary renal cell carcinoma (n =1 ),renal hemangiosarcoma (n =1 ) ; pelvic transitional cell carcinoma (TCC) (n =1 ),pelvic and ureter TCC (n =6),ureter TCC (n =7),pelvic and ureter and urinal bladder TCC (n =1 ),4 cases of bladder malignant tumors (including 3 cases of bladder TCC and 1 case of borderline bladder tumor).Of the 22 cases,17 had a main clinical manifestation of gross hematuria and 2 had microscopic hematuria,and the rest 3 had no obvious symptom.The average age at diagnosis of these 22 cases was 54.3 ± 12.3 years,with a mean time of 53 months after kidney transplantation.Ten cases received immunosuppressive treatment by using cyclosporine A (CsA) + azathioprine (Aza) + prednisone (Pred),while the remaining 12 received CsA + MMF + Pred.Surgical treatment was carried out in all cases:radical nephrectomy was conducted for 3 cases of renal carcinoma; total resection of kidney,ureter and sleeve-shaped resection of bladder in affected side were conducted for the 15 cases of pelvis or ureter carcinoma; for the 4 cases of bladder carcinoma,transurethral resection of bladder tumor was conducted for 3 cases while partial cystectomy was conducted for the other one case.Results During a follow-up period of 2 to 97 months,there were 9 deaths 6 to 97 months after toumorectomy.One died of bone metastasis,one pulmonary metastasis,two brain metastasis,two hepatic metastasis,and three extensive metastatic tumor soon after the diagnosis.Thirteen patients survived through the follow-up,with the longest survival time being 92 months in one patient with urinary bladder tumor.Four patients survived longer than 4 years,and 5 cases longer than 1 year.Conclusion Urological de novo malignant tumor is an important complication after renal transplantation with a main clinical manifestation of painless gross hematuria,and surgical resection is the most important treatment.

Objective To review the literature and synthesize current evidence on the use of kidneys with small renal cancer as donor kidneys.Method To locate eligible studies,four bibliographic databases including PubMed,Embase,Cochrane Library and ClinicalTrials.gov were screened,while key informants were collected and bibliographies of included studies were scrutinised.Two reviewers independently assessed studies for inclusion,extracted data.Data were synthesised as a narrative review.Results 1680 articles were found while eventually 15 studies were selected for this systematic review.All of the 15 included studies were case reports or case series.Totally 96 documented cases of donor kidneys after resection of small renal cancer were transplanted and no definite recurrence happened.Conclusion It is suggested from current limited evidence that cancer recurrence rate of allotransplanting kidney after resection of SRC was relatively low,thus it deserved much more well-designed clinical trials and clinical use.

BACKGROUND: Ureteral obstruction is mainly caused by surgical technic, ischemic, and peripheral lesion compression as well as rejection; in particular, the surgical technic factor is the most important. How to effectively reduce ureteral complications following renal transplantation is significant for prompt diagnosis and clinical treatment.OBJECTIVE: To retrospectively analyze the diagnosis of 23 cases with ureteral complications following renal transplantation, and to summarize pathogeny and preventing management.METHODS: The retrospective analysis was conducted on 23 (1.98%) out of 1 160 cases with ureteral complications following renal transplantation who were selected from General Hospital of Jinan Military Area Command of Chinese PLA from January 1998 to December 2008. In 924 cases of renal transplantation with cadaver kidneys, ureteral stenosis occurred in 18 cases (1.95%), while in 236 cases with relative kidneys, ureteral stenosis occurred in 5 cases (2.12%). A total of 17 cases were performed with ureterovesicostomy; 2 with uretero-autoallergic anastomosis of ureter; 1 with cutaneous ureterostomy; 1 with ureteral liberation, resetting ureteric branch stand; 1 with saccule dilation; 1 with retrograde ureteric branch stand under cystoscope. Type-B ultrasonic examination was re-checked to determine pyeloureterectasis following treating ureteral complications.RESULTS AND CONCLUSION: Of the 23 cases, stenosis of ureterovesical junction occurred in 19 cases, necrosis of the ureter on 2 cases, and twisting of ureter graft on 2 cases. Following up was performed after treatment for 3-98 months. In 20 cases, renal pelvis and urinary bladder of transplanted kidney were smooth, and function was recovered remarkably. At 4 days after surgery, serum creatinine level was decreased, and no recurrence was rechecked postoperatively. One patient had skin stoma for 8 years at least postoperatively, and the renal function was still normal. The skin stoma was replaced regularly. Therapeutic effect was poor in a patient with distension and 1 with detaining ureteric branch stand, and patients still had stricture of ureter,which was treated by a surgery. The results demonstrated that the etiology of ureteral obstruction after kidney transplantation was complex, and stenosis of ureterovesical junction was most common. Most of obstruction request surgical management. The graft function and the long-term graft survival were not affected by a correctly treated ureteral obstruction.

Objective To document the impact of conversion to mycophenolate mofetil (MMF)at different time points after transplantation on the renal function of renal function.Methods A longterm,multicenter,non-interventional and observational study was done.Two cohorts were included:One was Switch cohort (340 cases) including renal allograft recipients who switched to MMF at least 6 months after renal transplantation and followed up for 4 years after switch; The other was Stay cohort (123 cases),including renal allograft recipients who received MMF treatment after transplantation and followed up for 4 years after enrollment.Results GFR values of patients in Switch cohort was significantly increased after switch,and the change in GFR slope was 3.1 mL· min-1 · year-1 (P＜0.01).GFR values of patients in Stay cohort kept steady before and after enrollment,and the change in GFR slope was 0.44 mL·min-1 ·year-1 (P＞0.05).Statistically significant difference in the onset time of GFR decline (defined as 20％ decline from the baseline) was observed among subgroups within Switch cohort (P＜0.01),but there was no significant difference among subgroups within Stay cohort (P＞0.05).Stay cohort was 12％ higher than in Switch cohort every year.Conclusion Conversion to MMF ＞6 months or even many years after transplantation can obviously improve the renal function of recipients.The earlier conversion can benefit improvement of the renal function.