Objective To study the dynamic changes and clinical significance of D-D, t-PA and PAI in patients with acute renal failure during the process of different methods of blood purification. Methods Thirty-seven ARF patients were divided into three groups: HD group, HDF group and HF group. Plasma D-D level, t-PA and PAI activity were determined 1 hour, 4 hours before and after treatment. Normal control group consisted of fourteen healthy people. Results ① Plasma D-D level and PAI activity in ARF patients were obviously higher than those in control group, while t-PA activity was lower(P0.05). ③ After 4 hours of the treatment, compared with HD group, HDF and HF groups had significant difference in plasma D-D level, t-PA and PAI activity(P

Objective To construct and identify the Gpx1-Klk1 vector which contains kidney-specific promoter (Ksp-cadherin). Methods Through PCR amplification, the human Gpx1, Klk1, and Ksp-cadherin eDNA were obtained by taking Gpx1 cDNA, Klk1 eDNA, and Ksp-cadherin BAC as templates. After being testified, the PCR products were inserted into the expressive vector pIRES-EGFP step-by-step to produce a recombinant vector Ksp-cadherin-Gpx1-Klk1. This vector was examined by restriction enzyme digestion and sequence analysis. Results The recombinant expressive vector Ksp-cadherin-Gpx1-Klk1 was successfully constructed. Conclusion The construction of the recombinant vector Ksp-cadherin-Gpx1-Kik1 laid foundations for investigations in establishing transgenic animal models, the over-expression of Gpx1 and Kikl in mammal kidney, and gene therapy for ischemia-reperfnsion injury during kidney transplantation.

Objective To explore the protective role of PR-39 on the ischemia reperfusion injury renal tissue of rats.Methods 60 male SD rats were enrolled and randomly divided into experimental KP group and negative control KE group.The rats orthotopic renal transplantation model were established.The recombinant adenoviral vectors containing promoter KSP and PR-39 gene (KP) or none (KE) were injected via renal artery.HE staining,immunohistochemistry and TUNEL staining were performed on the rats' renal tissues at 2 days after IRI modeling,and the renal tubular interstitial injury score and peritublar capillary rarefaction was also evaluated.The renal function related factors of rats was monitored before and after IRI,and the blood urea nitrogen and creatinine level was also compared between KP and KE groups.Results Blood urea and creatinine concentration was increased,part of glomerular and tubular injury in renal tissue were also visible in rats underwent renal IRI,which proved the rat orthotopic renal transplantation model were successfully estabilshed.PR-39 gene specifically expressed in renal interstitial tissue,but not in glomerular.The degree of kidney tublar injury and the number of apoptotic cells were lower in KP groups by comparing with negative control KE groups.Renal tubular injury was significantly decreased in group KP than in group KE.Peritubular capillary rarefaction index is smaller in KP than in KE group.The blood urea nitrogen and creatinine level in KP group were significantly lower than those in KE group,and the renal function were also recovered more quickly.Conclusion The specific expressed PR-39 in renal interstitial and tubule,can inhibit the apoptosis of renal tubular epithelial cells and promote the angiogenesis of peritubular capillary,so as to exert its protective role on IRI renal tissue.

Objective To evaluate the clinical value of adenosine triphosphate (ATP) determination in CD4+ cells in cytomegalovirus pneumonia after renal transplantation.Methods The ATP level of CD4+ T cells was measured by ImmuKnowTM kit.The ATP levels were determined in 187 renal transplant recipients before and 30,60,90,180 days after operation,and at the time of CMV pneumonia and 4 weeks after treatment of CMV pneumonia.The associations between ATP levels and CMV pneumonia were analyzed.Analysis of variance (ANOVA),Pearson-Spearman and relative risks were used for data analysis.Results 17 cases out of 187 renal transplant recipients were diagnosed as CMV pneumonia (9.1％),and the onset of CMV pneumonia started on the (2.8 ±1.2)month after renal transplantation.ATP concentrations in CD4+ T cells were significantly lower after operation than those before operation (P＜0.01).ATP concentrations reached the lowest on the about postoperative day 90 (P＜0.05),then increased gradually.In 17 recipients with CMV pneumonia,the ATP levels before and 30,90 days after operation,at the time of CMV pneumonia and 4th week after treatment of CMV pneumonia were (376 ±182),(283 ± 146),(196 ± 112),(145 ± 102) and (236 ± 117) μg/L respectively.ATP levels at the time of CMV pneumonia were significantly lower than any other time points (P＜0.05).There was close correlation between ATP levels and CMV pneumonia.Conclusion The determination of ATP in CD4+ cells could reflect the status of cell-mediated immunity in renal transplant recipients,and could evaluate the severity and prognosis of CMV pneumonia and guide the clinical treatment.

Objective To explore the relationship between adjustment of immunosuppressant and prognosis in renal transplantation recipients with pulmonary infection. Methods The clinical data of 98 patients with pulmonary infection following renal transplantation were retrospectively analyzed.Patients were divided into two groups: conventional group (n = 45) and immunosuppressant adjustment group (n = 53). The mortality, recovery time and rejection rate in two groups were analyzed under the statement of serious infection (SOFA≥12) and slight infection (SOFA＜ 12) by sequential organ failure assessment (SOFA) score. Results When the SOFA scores ≥ 12, the mortality and recovery time in immunosuppressant adjustment group were significantly lower than in conventional group (P＜0.05), but there was no significant difference in the rejection rate between two groups (P＞0.05). When the SOFA scores ＜11, there was no significant difference in mortality and recovery time between the two groups (P＞0.05). The incidence of rejection in immunosuppressant adjustment group was significantly higher than in conventional group (P＜0.05).Conclusion Mortality could be decreased and course of anti-infection treatment could also be shortened by adjusting the immunosuppressant in renal transplantation recipients with serious pulmonary infection (SOFA≥12). Immunosuppressant agent was proposed to maintain the original treatment protocol when the infection was slight (SOFA＜12).

Objective To study the expression of immunoglobulin-like transcripts 3 (ⅡT3) and ILT4 in peripheral blood dendritic cells (DC) of kidney transplantation recipients and to analyze its significance in immunity hyporesponsiveness of transplantation. Methods Twenty kidney allograft recipients who were survived more than five years were recruited to two groups: renal function stable groups, chronic rejection groups, and 10 healthy volunteers served as a control group. The peripheral blood mononuclear cells (PBMC) were stimulated with granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin 4 (IL-4) and immature DC were obtained. The expression of ILT3 and ILT4 was detected by using flow cytometry. The level of HLA-G5 in serum was determined by using enzyme linked immunosorbent assay. Results ILT3 expression in renal function stable group was increased and decreased in chronic rejection groups as compared with control group (P＜0.05),but ILT4 expression had no significant difference among all groups. HLA-G5 in serum was significantly increased in renal function stable group as compared with other groups. Conclusion Expression of ILT3 and HLA-G was increased in the kidney transplantation recipients with stable renal function and long-term survival, suggesting that they may play an important role in inducing and maintaining periphery immune tolerance.

Objective To investigate the clinical value of color Doppler flow imaging (CDFI) for evaluating transplant renal artery stenosis (TRAS).Methods Clinical and ultrasonographic data of 216 kidney transplant recipients were collected by follow-up monitoring from September 2015 to July 2016.CDFI indexes included the peak systolic velocity (PSV) in the renal artery and resistant index (RI).Renal artery PSV and RI were measured.All suspected TRAS patients accepted transplant renal artery angiography (DSA).Results Fourteen patients with suspected TRAS accepted DSA,of which 12 patients were confirmed.The diagnostic accuracy of CDFI was 85.7％.When the POST-PSV ratio＞ 1 0,the sensitivity and specificity of diagnosis of TRAS were 91 ％ and 95 ％,respectively.CDFI indexes remarkably changed after the TRAS patients had undergone renal artery dilatation or stent implantation.PSV of the main renal artery and the POST-PSV ratio decreased significantly,and the PSV of interlobar arteries increased.Conclusions CDFI is a reliable first choice for screening transplant renal artery stenosis.The POST-PSV ratio has relatively higher sensitivity and specificity in the diagnosis of TRAS.

Objective To summarize the experience of minimally invasive treatment in upper ureteral calculi complicated with urinary tract infection.Methods Retrospectively analyzed the clinical data of 40 cases with upper ureteral calculi complicated with urinary tract infection who were treated from December 2009 to December 2013.Results Twenty-one cases were performed with retrograde catheterization at cystoscopy and 11 cases were performed with percutaneous nephrostomy directed by B-ultrasound in the stage Ⅰ,the infection were controlled after operation 2-6 d.These patients were successfully cured by extracorporeal shock-wave lithotripsy (ESWL),ureterorenoscope lithotripsy (URL) or percutaneous nephrolithotomy (PCNL) in the stage Ⅱ].The remaining 8 cases were successfully cured by URL with antiinfection therapy in the stage Ⅰ.All patients had no ureteral perforation,laceration,urine derived sepsis and severe bleeding complications.All of ureteral calculi were drained after 2-10 weeks.The average hospital stay was 13.4 d.Patients were followed up for 1-12 months after the stone expulsion,the average was 6 months.There was 3 patients who with preoperative renal dysfunction had been improved after URL,and other patients' renal function returned to normal.Conclusions The therapy of retrograde catheterization at cystoscopy and percutaneous nephrostomy directed by B-ultrasound in the stage Ⅰ,combined with ESWL,URL or PCNL in the stage Ⅱ in treating upper ureteral calculi complicated with urinary tract infection have more advantage such as less complication,rapid control of infection and complete removal of stones.It is an ideal method.

The feasibility and the clinical value of the enzyme-multiplied immunoassay technique (EMIT) monitoring of blood concentrations of cyclosporine A (CsA) in patients treated with CsA were investigated after kidney transplantation.The validation method was performed to the EMIT determination of CsA blood concentration,the CsA whole blood trough concentrations (Co) of patients in different time periods after renal transplantation were monitored,and combined with the clinical complications,the statistical results were analyzed and compared.EMIT was precise,accurate and stable,also with a high quality control.The mean postoperative blood concentration of CsA was as follows:＜1 month,(281.4± 57.9)ng/mL; 2 - 3 months,(264.5 ± 41.2)ng/mL; 4 - 5 months,(236.4 ± 38.9)ng/mL; 6 - 12 months,(206.5 ± 32.6)ng/mL; ＞12 months,(185.6 ± 28.1)ng/mL.The toxic reaction rate of CsA blood concentration within the recommended therapeutic concentration was 14.1％,significantly lower than that of the none-recommended dose group (37.2％) (P＜0.05); the transplantation rejection rate was 4.4％,significantly lower than that of the nonerecommended dose group (22.5％) (P＜0.05).Using EMIT to monitor the blood concentration of CsA as the routine laboratory method is feasible,and is able to reduce the CsA toxicity and rejection significantly,leading to achieving the desired therapeutic effect.

Objective To explore the clinical effect of renal transplant from donation after citizen's death (DCD) donors with acute kidney injury (AKI).Methods This was an observational retrospective study of 622 patients who underwent renal transplantation from 312 DCD donors' kidneys at the First Affiliated Hospital of Xi'an Jiaotong University from December 2011 to December 2016.The transplant patients were divided into AKI group and non-AKI group according to the Acute Kidney Injury Network (AKIN) criteria based on initial and terminal creatinine values.We evaluated and compared transplant outcomes of these two groups.Results There were 131 donors with AKI,and the incidence of AKI was 42.0 ％.AKI group and non-AKI group recipients respectively had DGF in 20.2％ and 7.2％ of cases (P＜0.01),153.6 ± 56.2 and 119.3 ± 40.7 μmol/L of serum creatinine (SCr) levels at 1st month (P＜0.01),and 38.5 ± 14.1 and 57.6 ± 23.4 ml· min-1 (1.73 m2)-1 of eGFR at 1st month (P＜0.01).There was no significant difference in SCr and eGFR between two groups at 1st year after transplantation.Conclusion Most of kidneys from DCD donors with AKI can be considered for transplantation.Renal transplantation of organs from DCD donors with AKI showed greater DGF but good outcomes.