Reliability of neutrophil gelatinase-associated lipocalin in detecting acute tubular necrosis in decompensated cirrhosis:Systematic review and meta-analysis

BACKGROUND Acute kidney injury(AKI)in cirrhosis is common.The diagnosis of AKI in cirrhosis patients depends on clinical presentation and laboratory tests like serum creatinine.However,urine biomarkers could also be used to assess the type of AKI and the severity of the disease.We performed a systematic review with metaanalysis to evaluate the association with urine neutrophil gelatinase-associated lipocalin(NGAL)marker in identifying acute tubular necrosis(ATN)in patients with cirrhosis.AIM To assess the reliability of urine NGAL in the detection of ATN in patients with cirrhosis.METHODS We systematically searched MEDLINE and PubMed using keywords including“urine biomarkers”,“NGAL”,“kidney dysfunction”,and“cirrhosis”to identify relevant studies.Data was screened and extracted.Included studies assessed hospitalized cirrhosis patients with AKI using the urine NGAL biomarker.We synthesized the data using diagnostic odds ratio(DOR),comparative and descriptive analyses,and Cochran Mantel-Haenszel(CMH)statistics to evaluate heterogeneity.RESULTS Three thousand seven hundred and one patients with cirrhosis were analyzed from a total of 21 cohort studies.The DOR of 14 of those studies[pooled DOR:22.150,(95%CI:17.58-27.89),P<0.0001]demonstrated a significant association between urine NGAL levels and its identification of ATN.Following stratification by cirrhosis status,heterogeneity was analyzed and showed a significant non-zero correlation between NGAL and AKI(CMH statistic=702.19,P<0.0001).CONCLUSION In patients with cirrhosis,the use of urine NGAL is a reliable biomarker for detecting ATN and identifying the etiology of AKI.

Clinical, Etiological and Progressive Aspects of Acute Tubular Necrosis of Toxic Origin at the Brazzaville University Hospital Center

Background and Objectives: Acute tubular necrosis (ATN) is the second cause of acute kidney injury (AKI) in an intra-hospital environment. The toxic origin is avoidable. Our objectives were to determine the toxic substances at the origin of ATN at the Brazzaville University Hospital and determine the evolving aspects and the factors associated with it. Patients and Methods: We carried out a 12-month from June 20, 2022 to June 30, 2023. It was a prospective observational study in the Nephrology Department of Brazzaville University Hospital Center. The diagnosis of ATN was done in the presence of AKI occurring in the context of taking nephrotoxic substances with negative albuminuria. Cases of ATN aggravating CKD were excluded. Data analysis was done with Epi-Info 7.2 software. Results: We identified 63 cases of AKI on toxic ATN. Their average age was 47 ± 19 years with a male predominance of 60.2%. The 3 main toxicants incriminated were: herbal medicine (49.2%), Gentamycin (17.5%) and non-steroidal anti-inflammatory drugs (14.3%). An indication for hemodialysis was made in 43 patients (68.2%), the evolution was marked by a cure in 29 patients (46.1%), 10 (15.9%) became chronic kidney failure, 19 (30.1%) died, 5 (7.9%) were lost to follow-up. The main factor for non-healing is anuria (p Conclusion: The main cause of toxic ATN at Brazzaville University Hospital is herbal medicine. The death rate is high there.

Prucalopride-associated acute tubular necrosis

We report the first case of acute renal failure secondary to prucalopride, a novel agent for the treatment of chronic constipation. The 75 years old male patient was initiated on prucalopride after many failed treatments for constipation following a Whipple's procedure for pancreatic cancer. Within four months of treatment his creatinine rose from 103 to 285 μmol/L(e GFR 61 decrease to 19 m L/min per 1.73 m2). He was initially treated with prednisone for presumed acute interstitial nephritis as white blood casts were seen on urine microscopy. When no improvement was detected, a core biopsy was performed and revealed interstitial fibrosis and tubular atrophy. The presence of oxalate and calcium phosphate crystals were also noted. These findings suggest acute tubular necrosis which may have been secondary to acute interstitial nephritis or hemodynamic insult. The use of prednisone may have suppressed signs of inflammation and therefore the clinical diagnosis was deemed acute interstitial nephritis causing acute tubular necrosis. There are no previous reports ofprucalopride associated with acute renal failure from the literature, including previous Phase Ⅱ and Ⅲ trials.

Therapeutic effects of human umbilical cord-derived mesenchymal stem cells against acute tubular necrosis quantified through measures of iNOS, BMP-7 and Bcl-2

Introduction: Acute tubular necrosis (ATN) is the most prevalent cause of acute renal failure (ARF). Mesenchymal stem cell transplantation has been studied as a potential treatment for renal dysfunction due to ATN. Inducible nitric oxide synthase (iNOS), bone morphogenetic protein-7 (BMP-7) and B-cell lymphoma 2 (Bcl-2) are surrogate markers of renal tubular epithelial regeneration and subsequent recovery of renal function following ATN. Methods: Serum creatinine (Scr) and blood urea nitrogen (BUN), as well as expression of iNOS, BMP-7 and Bcl-2 in gentamycin-induced ATN rat kidneys was investigated after human umbilical cord-derived mesenchymal stem cell (HUC-MSC) transplantation. Immunohistochemical staining was performed in 3 groups of rats: gentamycin-induced ATN treated with HUC-MSC, gentamycin-induced ATN without HUC-MSC, and untreated rats not receiving any treatments. Results: HUC-MSC transplantation led to a reduction in Scr and BUN in the kidneys of rats with gentamycin-induced ATN. Expression of iNOS in the HUC-MSC treated group occurred later and the expression levels were much lower during gentamycin-induced ATN compared to rats with ATN that were not treated with HUC-MSC. The expression of BMP-7 and Bcl-2 in the MSC-transplanted group was significantly increased compared to both control groups of rats with injured and healthy renal tubules. Conclusions: HUC-MSCs induce renal protection in a rat model of gentamycin-induced ATN, which is associated with reduced iNOS expression and up-regulation of Bcl-2 and BMP-7.

Approach to Acute Kidney Injury: Diagnosis and Management

Acute kidney injury is a critical but commonly occurring medical condition that presents with a sudden decline in kidney function. This comprehensive review article provides an in-depth examination of the risk elements, etiology, diagnosis, management, and preventive approach of AKI. The causes that contribute to the development of AKI include prerenal, intrinsic renal, and postrenal. The diagnostic approach to AKI includes clinical, laboratory, and imaging studies to evaluate the root cause analysis and to find out the severity of kidney injury. Timely and accurate diagnosis is crucial for initiating appropriate management strategies. The treatment strategies may include fluid and electrolyte management, medication adjustments, nutritional support, and renal replacement therapy. The prospect of recovery diverges as it relies on the individual factors, reasons, and gravity of the condition. This review highlights the importance of raising awareness among healthcare professionals and the public about AKI, early recognition of risk factors, and prompt management. Further research is needed to explore novel therapeutic approaches and refine existing management guidelines for this critical condition.

Acute Kidney Injury (AKI) in the Setting of Multi-Organ Dysfunction Syndrome (MODS) Secondary to Yellow Fever Infection (YFI) in a 19-Year-Old Woman

Background: Outbreak of yellow fever infection (YFI), a mosquito-borne disease, occurs sporadically worldwide especially in tropical nations. Acute kidney injury (AKI) commonly results from YFI and could be associated with a poor prognosis for victims even under intensive care unit (ICU). Pathophysiologic mechanisms for AKI include hypovolemic shut down, cytotoxicity, acute tubular necrosis (ATN), hemolysis, or coagulopathy. Early diagnosis, prompt and effective treatment modalities including dialysis improve treatment outcome. Aim: We report the case management of a 19-year-old woman who had yellow fever infection complicated by acute kidney injury in the setting of multi-organ dysfunction syndrome (MODS). Case Presentation: A 19-year-old woman who presented with fever, headache and vomiting for 2 weeks. In the course of the illness, urine volume became reduced and coke colored, followed by body swelling, yellowness of the eyes bleeding from the orifices. Examination revealed an acutely ill looking woman, icteric, and with pedal edema. Her pulse was 100/min and blood pressure was 120/80 mmHg. Liver was enlarged, soft and tender. She had proteinuria 3+ and polymerase chain reaction (PCR) confirmed yellow fever infection. She had markedly deranged serum biochemical parameters for which she had a three-hour session of hemodialysis with Heparin anticoagulation. The urea reduction ratio (URR) was 46.9%. Barrier nursing was commenced. She had 7 units of whole blood and a pint of fresh frozen plasma (FFP) with antibiotics, Rabeprazole, Tranexamic acid, Vitamin K and Frusemide. She had the second dialysis session of HD and entered into the recovering phase of AKI and was subsequently discharged after 18th days on admission. Conclusion: Yellow fever infection occurs sporadically and could lead to MODS involving the kidneys, liver and hematologic system. Prompt initiation of dialysis, correction of coagulopathy, and antibiotics use are measures needed to arrest progression and death. Vaccination, destruction of the natural habitat of the carrier and infective organisms are necessary particularly in endemic regions of the world.

Nephropathy in dietary hyperoxaluria:A potentially preventable acute or chronic kidney disease

Hyperoxaluria can cause not only nephrolithiasis and nephrocalcinosis,but also renal parenchymal disease histologically characterized by deposition of calcium oxalate crystals throughout the renal parenchyma,profound tubular damage and interstitial inflammation and fibrosis.Hyperoxaluric nephropathy presents clinically as acute or chronic renal failure that may progress to endstage renal disease(ESRD).This sequence of events,well recognized in the past in primary and enteric hyperoxalurias,has also been documented in a few cases of dietary hyperoxaluria.Estimates of oxalate intake in patients with chronic dietary hyperoxaluria who developed chronic kidney disease or ESRD were comparable to the reported average oxalate content of the diets of certain populations worldwide,thus raising the question whether dietary hyperoxaluria is a primary cause of ESRD in these regions.Studies addressing this question have the potential of improving population health and should be undertaken,alongside ongoing studies which are yielding fresh insights into the mechanisms of intestinal absorption and renal excretion of oxalate,and into the mechanisms of development of oxalate-induced renal parenchymal disease.Novel preventive and therapeutic strategies for treating all types of hyperoxaluria are expected to develop from these studies.

Clinicopathological spectrum of snake bite-induced acute kidney injury from India

AIM To study the clinico-pathological spectrum of snake bite-induced acute kidney injury(AKI).METHODS A retrospective study of patients admitted at Indira Gandhi Medical College Hospital,Shimla with snake bite-induced AKI from July 2003 to June 2016.Medical records were evaluated for patient's information on demographic,clinical characteristics,complications and outcome.Outcomes of duration of hospital stay,requirement for intensive care unit support,treatment with dialysis,survival and mortality were analyzed.The survival and non survival groups were compared to see the difference in the demographic factors,clinical characteristics,laboratory results,and complications.In patients subjected to kidney biopsy,the findings of histopathological examination of the kidney biopsies were also analyzed.RESULTS One hundred and twenty-one patients were diagnosed with snake bite-induced AKI.Mean age was 42.2 ± 15.1 years and majority(58%) were women.Clinical details were available in 88 patients.The mean duration of arrival at hospital was 3.4 ± 3.7 d with a range of 1 to30 d.Eighty percent had oliguria and 55% had history of having passed red or brown colored urine.Coagulation defect was seen in 89% patients.The hematological and biochemical laboratory abnormalities were:Anemia(80.7%),leukocytosis(75%),thrombocytopenia(47.7%),hyperkalemia(25%),severe metabolic acidosis(39.8%),hepatic dysfunction(40.9%),hemolysis(85.2%) and rhabdomyolysis(68.2%).Main complications were:Gastrointestinal bleed(12.5%),seizure/encephalopathy(10.2%),hypertension,pneumonia/acute respiratory distress syndrome(ARDS) and disseminated intravascular coagulation(9.1% each),hypotension and multi organ failure(MOF)(4.5% each).Eighty-two percent patients required renal replacement therapy.One hundred and ten(90.9%) patient survived and 11(9.1%) patients died.As compared to the survival group,the white blood cell count(P = 0.023) and bilirubin levels(P = 0.006) were significant higher and albumin levels were significantly lower(0.005) in patients who died.The proportion of patients with pneumonia/ARDS(P = 0.001),seizure/encephalopathy(P = 0.005),MOF(P = 0.05) and need for intensive care unit support(0.001) was significantly higher and duration of hospital stay was significantly shorter(P = 0.012) in patients who died.Kidney biopsy was done in total of 22 patients.Predominant lesion on kidney biopsy was acute tubular necrosis(ATN) in 20(91%) cases.In 11 cases had severe ATN and in other nine(41%) cases kidney biopsy showed features of ATN associated with mild to moderate acute interstitial nephritis(AIN).One patient only had moderate AIN and one had patchy renal cortical necrosis(RCN).CONCLUSION AKI due to snake bite is severe and a high proportion requires renal replacement therapy.On renal histology ATN and AIN are common,RCN is rare.

Acute renal failure associated with acute non-fulminant hepatitis B

A 38-year-old female presenting with a high fever of 39 ℃ developed severe liver dysfunction and acute renal failure(ARF).In tests for a hepatitis associated virus,an Immunoglobulin M-anti-hepatitis B virus core antibody was the only positive finding.Moreover,the progression of ARF coincided with the pole period of liver damage and all the other assumed causes for the ARF were unlikely.Therefore,this case was diagnosed as ARF caused by acute hepatitis B.ARF associated with non-fulminant hepatitis has been infrequently reported,usually in association with acute hepatitis A.This case is considered to be an extremely rare and interesting case.

尿胱抑素C预测非少尿型ATN近期结局的临床应用价值

目的:探讨尿胱抑素C预测非少尿型急性肾小管坏死(acute tubular necrosis,ATN)近期是否需要肾替代治疗(renal replacement therapy,RRT)的临床应用价值。方法:用ELISA法检测64例非少尿型ATN患者(均在发病3日内)的尿胱抑素C水平,观察此64例患者15日后的结局,根据有否行RRT分为RRT组及非RRT组,比较2组进入研究时的血清肌酐水平、尿流速、LIANO积分、尿胱抑素C水平,并比较后两者的接收者工作特征(receiver operating characteristic,ROC)曲线。结果:21例进入RRT组,余43例为非RRT组。2组进入研究时的血清肌酐及尿流速比较,差异均无统计学意义(均为P>0.05);而进入研究时,RRT组的尿胱抑素C水平比非RRT组显著升高(P<0.01);2组的LIANO积分比较差异亦有统计学意义(P<0.05)。通过比较两者的ROC曲线,前者的敏感度、特异度均高于后者。结论:尿胱抑素C在近期结局不同的非少尿型ATN患者中存在明显的差异,可作为预测此类患者是否需要行RRT治疗的指标,其敏感度及特异度均高于LIANO积分,具有重要的临床应用价值。

彩色多普勒超声在肾移植术后AR与ATN鉴别诊断中应用

目的：探讨彩色多普勒超声对肾移植术后急性排斥反应（AR）与急性肾小管坏死（ATN）鉴别诊断的价值。方法：选取2000年1月-2007年12月的肾移植患者135例，分为功能正常组、AR组和ATN组行彩色多普勒超声检查，观察移植肾形态结构、血流灌注及血流指数变化并作比较。结果：AR组移植肾长径、实质厚度较功能正常组明显增大（P〈0．01）；而ATN组移植肾长径、实质厚度较功能正常组略有增大，差别无明显统计学意义（P〈0．05）。AR组和ATN组阻力指数（RI）明显高于功能正常组（P〈0．01），而AR组和ATN组之间差别无统计学意义（P〉0．05）。结论：彩色多普勒超声测得移植肾RI和其他血流动力学变化不能用作鉴别AR和ATN的绝对依据，需要综合移植肾声像图改变来协助鉴别AR和ATN。

超声影像组学对移植肾实质性病变鉴别诊断的价值

目的探讨超声影像组学对移植肾实质性病变组织学的诊断价值。方法选取186例因血肌酐异常而行肾穿刺活检的同种异体肾移植患者,根据活检结果分为急性排斥反应组(AR组)135例和肾小管坏死组(ATN组)51例。收集移植肾穿刺活检结果和超声资料,由2位医师根据常规超声参数进行诊断;应用影像组学进行超声图像特征提取,对获得的全部组学特征数据采用独立样本t检验进行初次筛选,再使用最小绝对值收敛和选择算子(LASSO)算法从已筛选特征中选择最优有效特征,并利用随机森林、K近邻法、逻辑回归、支持向量机分类器建立预测模型。所有患者按照7∶3的比例分配到训练队列和验证队列,采用5折交叉验证策略分析各组学模型在验证队列的准确度、敏感度、特异度、ROC曲线下面积(AUC)。结果医师组以常规超声参数为特征对AR和ATN鉴别诊断的敏感度为56.2%,特异度为60.7%,准确度为57.5%。应用影像组学方法每幅图像提取137个组学特征,经过筛选后最终保留6个有意义的特征,分别为2D形状-平坦度、一阶-最小值、直方图-最小值、直方图-体素计数、梯度-标准差、灰度共生矩阵-集群阴影。随机森林、支持向量机、逻辑回归和K近邻法4种模型的AUC分别为0.931(95%CI:0.779~0.997)、0.762(95%CI:0.604~0.897)、0.721(95%CI:0.582~0.808)和0.713(95%CI:0.508~0.796),其中随机森林模型敏感度为97.60%,特异度为80.00%,准确度为85.80%,综合表现最优。结论超声影像组学可以提取更多的超声图像特征,各组学模型对移植肾实质性病变组织学分型均具有较好的鉴别诊断价值,优于常规超声方法。

司库奇尤单抗联合预防性抗结核治疗斑块型银屑病致急性肾损伤1例报告

1病例资料患者男,54岁,因“恶心、呕吐2周,血肌酐升高4 d”于2022年8月12日收入我科治疗。2022年7月初患者因全身皮肤弥漫性红色丘疹、斑块,伴脱屑、瘙痒就诊于我院皮肤科门诊,诊断为斑块型银屑病(中重度),因既往激素等治疗无效,拟给予司库奇尤单抗(可善挺®,辉瑞制药有限公司)治疗,用药前肝肾功能和尿常规检查均未见异常,血肌酐72μmol/L。因患者既往有肺结核病史,结核感染T细胞检测阳性,胸部CT示“两肺多发实性小结节,右上肺为著,右上肺索条影”,2022年7月18日上海市肺科医院肺结核科会诊后建议给予预防性抗结核治疗。

急性肾小管间质性肾炎与急性肾小管坏死的临床鉴别分析

目的:分析急性肾小管间质性肾炎(acute tubulointerstitial nephritis,ATIN)患者的临床及实验室检查特征,探讨该病与急性肾小管坏死(acute tubular necrosis nephritis,ATN)的鉴别诊断要点。方法:纳入2009年1月至2018年12月间在上海交通大学医学院附属瑞金医院肾脏科经肾活检病理诊断为ATIN、ATN的患者,收集其临床表现和实验室检查数据,并对两者进行比较分析。结果:10年间我院肾脏科行经肾活检的病例总计5537例,其中诊断为ATIN的患者共135例(2.4%,135/5537),诊断为ATN的患者109例(2.0%,109/5537)。ATIN占急性肾脏病(acute kidney disease,AKD)肾活检患者的21.4%(135/630)。ATIN患者的中位确诊年龄为53岁,女性占57.0%,临床主要表现为发热、皮疹、关节痛,常见诱因为感染、药物应用和毒物接触。与ATN组相比,ATIN患者中女性占比高(57.0%比33.9%),平均体重指数(body weight index,BMI)低(22.9±3.6比24.6±3.9,P<0.01),且发生急性肾损伤(acute kidney injury,AKI)(14.8%比64.2%)、少尿(17.0%比48.6%)及入院后需紧急透析(19.3%比39.4%)的百分比低(P<0.01)。ATIN患者入院时,血红蛋白(hemoglobin,Hb)[(100.9±20.9)g/L比(116.7±29.8)g/L]和血尿素氮/肌酐比值(blood urea nitrogen/creatinine ratio,BCR)(11.8±5.4比14.6±11.0)均较ATN组低(P<0.01)。多因素回归分析显示,入院时高白蛋白(>55 g/L)、低血清肌酐(serum creatine,Scr)(<62μmol/L)、低血清尿酸(urine acid,UA)(<208μmol/L)、低Hb水平(<130 g/L)与ATIN相关,联合这4项指标建立的预测模型,其诊断ATIN的受试者操作特征曲线下面积为0.798(95%CI为0.742~0.853),灵敏度为74.4%,特异度为71.4%。结论:ATIN在上海地区人群接受肾活检的AKD患者中占比高,好发于中年女性,半数患者诱因不明。患者入院时的白蛋白、Scr、Hb及UA水平有助于ATIN与AIN间的鉴别,基于上述4项指标构建的ATIN患者诊断预测模型具有较好的特异度和灵敏度。

NGAL尿血比值在肝硬化急性肾损伤中的鉴别诊断价值

背景中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)在肝硬化合并急性肾损伤(acute kidney injury,AKI)患者中对于急性肾小管坏死(acute tubular necrosis,ATN)与其他类型的AKI有重要的鉴别诊断价值,但血NGAL与尿NGAL直接相关,现有研究中对于NGAL尿血比值在ATN的鉴别诊断中的作用的研究很少,本试验意在评估其比值的临床作用.目的分析血尿NGAL及其尿血比值在肝硬化合并AKI患者中对于ATN的鉴别诊断价值.方法选取失代偿期肝硬化患者180例,其中合并AKI患者98例,根据AKI病因分成不同亚组,包括33例肾前性氮质血症,25例肝肾综合征急性肾损伤型及40例ATN,探讨血尿NGAL及其尿血比值在不同类型AKI中鉴别作用.结果尿NGAL对于肝硬化合并AKI患者中ATN的鉴别诊断价值较高,受试者工作曲线下面积(area under the curve,AUC)是0.964,诊断临界值为271.35 ng/mL时,敏感度为87.5%,特异性为96.6%.NGAL尿血比值对于ATN诊断价值也较高,AUC为0.953,诊断临界值在2.96时,敏感度为92.5%,特异性为91.4%.结论尿NGAL和NGAL尿血比值对于鉴别肝硬化合并AKI患者中ATN与其他类型AKI有重要价值,值得进一步研究及临床推广.

尿液NGAL、KIM-1、TFF3联合检测对肝硬化患者急性肾小管坏死的诊断价值

背景急性肾损伤(acute kidney injury,AKI)是失代偿期肝硬化患者常见的并发症,临床死亡率高且预后较差,其中急性肾小管坏死(acute tubular necrosis,ATN)预后最差,及时准确地识别ATN是临床难以解决的问题,既往研究显示,尿液中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、三叶因子3(trefoil factor 3,TFF3)及肾损伤因子-1(kidney injury molecule-1,KIM-1)对于肝硬化中ATN与其他类型的AKI有潜在的鉴别诊断价值,但诊断效能较低,仍不能进入临床应用,需进一步探究指标间联合检测能否提升生物标志物对于肝硬化合并ATN的诊断效能.目的分析尿NGAL、尿KIM-1、尿TFF3及两两指标间联合检测在肝硬化合并AKI患者中对于ATN的鉴别诊断价值,同时对尿NGAL等指标对于ATN鉴别诊断的临界值行进一步研究.方法选取失代偿期肝硬化患者190例,其中合并AKI患者108例,根据AKI病因分成不同亚组,包括33例肾前性氮质血症,27例肝肾综合征急性肾损伤型及48例ATN,探究尿NGAL、尿TFF3、尿KIM-1及指标间两两联合在肝硬化合并AKI患者中对于ATN的鉴别诊断价值.结果尿NGAL对于肝硬化合并AKI患者中ATN的鉴别诊断价值较高,受试者工作曲线下面积(area under the curve,AUC)是0.902,诊断临界值为271.8 ug/g Cr时,敏感度为81.3%,特异性为85.0%.指标联合可提高鉴别诊断能力,其中尿NGAL联合尿TFF3的诊断能力最强(AUC=0.933,敏感度为85.4%,特异性为88.3%).结论尿NGAL、尿KIM-1、尿TFF3对于鉴别肝硬化合并AKI患者中ATN与其他类型AKI有重要价值,2项指标间的联合检测可进一步提升诊断效能,值得进一步研究及临床推广.

肾移植术后穿刺活组织检查分类应用进展

移植肾活组织检查(活检)依然是诊断移植术后肾功能异常的“金标准”。肾移植术后穿刺活检依据患者肾功能分为指示性活检及程序性活检。指示性活检主要用于诊断肾移植并发症、判断病情严重程度并指导后续治疗;程序性活检主要用于定期监测肾移植受者移植肾功能,以排除亚临床排斥反应等并发症。因患者意愿等原因,程序性活检在我国未能广泛应用,指示性活检是现今主要的活检方式。目前指示性活检穿刺指征、程序性活检穿刺时机及必要性仍存在争议。本文对肾移植术后穿刺活检分类、基于活检的组织生物标志物研究进展进行综述,旨在为协助临床进行肾移植术后并发症的明确诊断和针对性治疗,进一步提高移植肾和受者的良好存活提供参考依据。

中药木通肾脏损害的临床和病理特征

目的:总结20例木通中毒病例肾脏损害的临床特点和肾活检病理改变特征。 方法:20例木通肾损害患者,男性17例,女性7例,年龄22~68岁。其中服药前有肾炎3例,尿路结石5 例。13例服木通汤药[(汤药组,再分为大剂量组(≥10g/d,n=9)和小剂量组(≦6g/d,n=4));7例服用含木通的中成药(成药组)。观察指标包括木通剂量,服药及发病时间、病程、首发症状、肾功能、尿液检查及肾活检病理。 结果:①发病过程及临床表现与木通剂量相关。出现症状时间分别为大剂量组4h(2h^6d)、小剂量组2 mo(2~6 mo)、成药组24 mo(6~36 mo)。大剂量组以消化道症状为首发症状,6例表现为急性肾衰(ARF),3例慢性肾衰(CRF);小剂量组及成药组以乏力、夜尿增多起病,表现为CRF。②患者尿蛋白均<1.5g/d[大剂量ARF组、大剂量CRF组、小剂量组及成药组分别为(1.00.3)、(0.980.2)、 (0.90.3) 、(0.80.2)g/d],无高尿酸血症,血尿及高血压发生率低。③大剂量ARF组50%为少尿型,糖尿(100%)及氨基酸尿(75%)阳性率高。肾活检表现为急性肾小管坏死,肾小管基膜(TBM)裸露现象普遍。5例转为CRF,重复肾活检显示小管间质出现慢性化病变。大剂量CRF组起病方式、尿液检查尤其糖尿(100%)及氨基酸尿(66.7%)阳性率与ARF患者比较无统计学差异,但病程显著延长(P<0.05)。

关木通与抗生素致急性肾小管坏死细胞生物学特征的比较研究

目的 :通过比较关木通致急性肾小管坏死 (ManchurianDutchmanspipe acutetubularnecrosis,MD ATN)与抗生素致ATN(antibiotic acutetubularnecrosis ,A ATN)两组病变中肾小管间质细胞表型特征及细胞外基质分泌的异同 ,初步探讨两者预后明显差异的细胞生物学机制。方法 :应用免疫组化SP法观察4例MD ATN和 5例A ATN患者的肾活检组织标本中 ,增殖细胞核抗原 (PCNA)、表皮细胞生长因子(EGF)、α 平滑肌肌动蛋白 (α SMA)、纤维连接蛋白 (FN)、Ⅲ型胶原、Ⅳ型胶原、转化生长因子 β1(TGFβ1)和结缔组织生长因子 (CTGF)表达程度的异同。针对两组患者临床预后的显著差别 ,重点从损伤修复及纤维化发生两个方面对上述指标进行分析。结果 :(1)MD ATN组肾小管上皮细胞 (RTEC)PCNA阳性率以及EGF表达均显著低于A ATN组 (P <0 0 1) ;(2 )两组肾小管间质内α SMA表达均增加 ,差异无显著性 ;(3)两组肾间质内均出现TGFβ1阳性细胞浸润以及CTGF的显著表达 ,两组间比较差异无显著性 ;(4 )MD ATN组肾间质内FN、Ⅲ型和Ⅳ型胶原的表达均较A ATN组明显增加 (P <0 0 1)。结论 :(1)与A ATN组比较 ,MD ATN患者RTEC损伤后自身修复能力减低 ,EGF低表达可能为其修复不良的原因之一。 (2 )MD ATN与A ATN患者肾间质内α SMA。

水蛭防治初发期急性肾功能衰竭的实验研究

为了观察水蛭对初发期急性肾小管坏死(ATN)的防治作用,用禁水16h的成年雄性SD大鼠肌肉注射甘油引起ATN,在初发期给以不同药液,观察到水蛭组3、24、48h Ber升高值,24、48h BUN升高值均明显低于自来水组和单纯禁水组,而与纠正对照异搏停组相似;3、24h肾脏组织形态学损伤水蛭组亦较自来水组和单纯禁水组明显减轻。结果表明,水蛭有防治初发期ARF的作用。