ObjectiveTo evaluate the advantages of color doppler ultrasonography guidence in mini-invasive percutaneous nephrostolithotripsy(mPCNL) for pediatric patients.MethodsFrom May 2006 to August 2011,a total of 165 pediatric cases with upper urinary stone,who were treated by mPCNL with F12-F16 access route,were respectively reviewed.All procedures were under the guidance of color doppler ultrasonography,and the pneumatic lithotripsy and/or EMS ultrasound lithotripsy were used to disintegrate the stones.ResultsIn one-stage mPCNL,The average length of the stones was ( 15.82 ±6.31 ) mm,all 165 cases were treated,during which percutaneous renal access was successfully established under color doppler ultrasound guidance and stones were fragmentated.The mean duration of renal access establishment was (11.7 ± 5.3 ) min.The one-stage stone free rate was 95.2％(157/165) with the operation time of (42.6 ± 20.1 ) min.The postoperative hemoglobin aud hematocrit decline were observed in 69.7 ％ ( 115/165 ) of the cases with the value of 2.67 g/L and 2.21％ respectively when compared with their preoperative counterpart. Infection rate related to operation was 23.03％ ( 38/165 ),which was demostrated by durative or iterative fever more than 48 hours.No perioperative bleeding was recorded,and no transfusion was required.No ease experienced perirenal organ injury.Conclusions Using color doppler ultrasound guidance during m-PCNL resulted in safe and effective therapeutic method for upper urinary stone,and can be considered as measures of choice for guidence of mPCNL in pediatric patients.

Objective To discusse the diagnosis and treatment of kidney stones with emphysema pyelonephritis.Methods The clinical data of 8 patients with kidney stones complicated with emphysema pyelonephritis diagnosed in our hospital from January 2015 to October 2018 were retrospectively analyzed.There were 5 males and 3 females.The average age was 50 years old.The clinical manifestations including chills fever in 6 cases,low back pain in 5 cases,nausea and vomiting in 3 cases.Six patients had diabetes,one had thalassemia,and two had contralateral kidney stones.The maximum cross-sectional area of stones was 737.6 mm2.Among the 8 cases,there were 7 cases which number of white blood cells and procalcitonin were higher than normal reference value.4 cases of hemoglobin ＜ 110 g/L,2 cases of platelet count ＜ 125 × 109/L.The patient was cultured with urine and/or blood and drainage fluid.5 cases were Escherichia coli,2 cases were infected with Proteus mirabilis,and 1 case was infected with Pseudomonas aeruginosa.According to the CT findings of emphysematous pyelonephritis reported in the literature,it was divided into type Ⅰ-Ⅳ:There were 2 cases of type Ⅰ,2 cases of type Ⅱ,3 cases of type Ⅲ,and 1 case of type Ⅳ.Results 4 cases of type [and type Ⅱ patients,2 cases without SIRS were given positive medical treatment to control infection then performed PCNL.2 cases with SIRS,first treated with percutaneous nephrolithotomy and active medical,after control infection the PCNL was performed.None of the 4 patients were treated with ICU and recovered well after surgery.Three patients with type Ⅲ and one patient with type Ⅳ were complicated with SIRS.Two of them underwent percutaneous nephrolithotomy in the emergency department.They were transferred to the ICU after surgery.After the infection and general condition improved,PCNL was performed.The postoperative recovery was satisfied.One patient percutaneous nephrolithotomy,due to poor drainage,secondary percutaneous nephrolithotomy,large intrachannel,low pressure perfusion in the operation of partial obstruction of renal pelvis stones,dredge obstruction,after ICU control infection PCNL was performed,postoperative recovery was good.One patient with type Ⅲ also had poor peritoneal drainage for the first time.Secondary percutaneous nephrolithotomy was performed.After the infection was controlled by ICU,PCNL was performed to remove the stones.However,because the patient had contralateral kidney stones and thalassemia,an epileptic-like reaction occurred during the anti-infection with imipenem,and a serious infection occurred again after the operation,and eventually the patient died.Conclusions Patients with type Ⅰ and Ⅱ emphysematous pyelonephritis with renal calculi treated with conservative medical treatment alone or combined with percutaneous renal puncture drainage with SIRS can achieve better therapeutic effects after PCNL surgery.Type Ⅲ,Ⅳ emphysema pyelonephritis with renal calculus patients need to be actively anti-infective accompany with percutaneous renal puncture drainage.When the stone leads to multiple renal pelvic obstruction,large channels,low-pressure perfusion can be used to crush stones,dredge obstruction.PCNL was performed after infection control.

Objective To explore the influence of living donor renal transplantation on the safety of donors.Methods Sixty-two donors who underwent living donor renal transplantation in the First Affiliated Hospital of Xinjiang Medical University from April 2003 to April 2007 were selected as research objects.The operation time and length of stay of donors were recorded.The occurrence of postoperative complication and prognosis were observed.Postoperative follow up included serum creatinine (Scr),blood urea nitrogen (BUN),glomerular filtration rate (GFR),plasma albumin,hemoglobin,blood pressure and the influence of kidney donation on life and work.Results The operations of 62 donors were successful.One case developed pneumothorax during open nephrectomy and another case developed fat liquefaction and necrosis of incision.Both of them were cured after symptomatic treatment.Two cases developed pulmonary infection postoperation and were cured after the treatment of sensitive antibiotics and aerosol inhalation.The other cases recovered smoothly after operation.In 62 donors,the average postoperative length of stay was (8.2 ±2.6)d,and the follow-up time was (3.2 ±1 .1 )years.All of the donors survived without influence on life and work.No significant difference was observed in the changes of Scr,BUN,GFR,plasma albumin,hemoglobin,blood pressure of the donors before operation and 7 d,3 months,1 year,3 years,5 years after operation (all in P >0.05).Conclusions The living donor nephrectomy is safe and feasible.It is very important for assuring the safety of donors to examine living donor perfectly before operation,be careful during operation,and closely follow up after operation.

Objective To investigate the protective effect and mechanism of Klotho protein on oxidative stress in renal tubular epithelial cells of experimental rat nodels of renal calcium oxalate stone.Methods The 30 SD rats,6-8 weeks old,were randomly divided into 3 groups (10 of each),normal control group(group A),calcium oxalate model group(group B),drug plus calcium oxalate model group (group C).Group A was established with physiological saline by garage each day,group B was established with 1％ ethylene glycol in drinking water + 2％ ammonium chloride by garage (2 ml/d),group C was established with Fosinopril 2.5mg + Valsartan 15mg aqueous solution 2 ml by gavage on the basis of group B (2 ml/d).4 weeks later,the level of malondialdehyde (MDA),superoxide dismutase (SOD),catalase (CAT) and glutathione peroxidase (GSH) in the kidney homogenate were measured by double antibody sandwich enzyme-linked immunosorbent assay (ELISA),Polymerase chain reaction (RT-PCR) was used to measure expression of Klotho and Nrf2 mRNA,and Western Blot was used to measure the expression of Klotho and Nrf2 protein.Results The level of MDA in group B [(12.43 ± 0.43) μmol/mg] was significantly increased compared to group A[(8.67 ±0.84) μmol/mg,P ＜0.05] and group C [(7.97 ±0.81) μmol/mg,P＜0.05],while group A was close to group C (P ＞0.05).In group A,B,and C,the levels of SOD were (247.89 ± 2.45),(109.54 ± 4.21),and (189.74 ± 10.47) U/mg,respectively;the levels of GSH were (38.98 ± 4.55),(26.87 ± 3.92),and (31.29± 2.54) μmol/mg,respectively;CAT were (138.47 ± 8.74),(119.87 ± 8.45),and (127.46 ± 7.45) U/mg,respectively.The levels of SOD,GSH,CAT in group B were significantly lower than that in group A and C,while those in group B were close to group A (P ＞ 0.05).The expression of Klotho and Nrf2 mRNA in group B [(0.208 ± 0.036) and (0.499 ± 0.086)] were significantly lower than group A (1.011 ± 0.174 and 1.023 ± 0.139,P ＜ 0.05)and group C(1.123 ±0.248 and 1.023 ±0.139,P ＜0.05).The expression of Klotho and Nrf2 protien were also significantly lower than that in group A and C (P ＜0.05).Conclusions Valsartan and Fosinopril could prevent the formation of renal CaOx stones by upregulating expression of low level Klotho gene induced by ethylene glycol.This effect may be involved with activation of Keapl-Nrf2-ARE signaling pathway.

BACKGROUND: As an emerging stem cell family, urine-derived stem cells have attracted more and more attentions in the tissue engineering construction. OBJECTIVE: To study the culture method of urine-derived stem cells, and to identify the biological characteristics of urine-derived stem cells. METHODS: Cleaning urine samples were harvested and centrifuged, and urine-derived stem cells were isolated from the urine samples and extensively expanded in vitro.Cell growth curve was measured by MTT method,and cell surface markers were detected by flow cytometry. Meanwhile, the cells were subjected to osteogenic and adipogenic induction. RESULTS AND CONCLUSION: Urine-derived stem cells were successfully isolated from the urine samples, which grew and proliferated rapidly. After subculture, the cells exhibited an S-shaped growth. The isolated urine-derived stem cells expressed CD29, CD44, CD73 and CD90, indicating that the cells maintained the activity of stem cells. Moreover, the isolated cells had the ability of osteogenic and adipogenic differentiation. To conclude, urine-derived stem cells have strong proliferation and differentiation potentials, as a kind of economic, convenient, non-invasive source of cells, which can provide great convenience for urethral defect repair and organ reconstruction.