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 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 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 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.

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.