ObjectiveTo study the change and significance of the serum nitric oxide (NO) level in patient with obstructive jaundice complicated with renal dysfunction. MethodsThe level of NO, BUN, Cr in serum and the activity of NOS in 25 patients with obstructive jaundice and renal dysfunction and 26 healthy adults was studied.ResultsThe patients’ serum NO level and the activity of NOS were significantly lower than those in the control group(P＜0.01)，whereas the serum BUN and Cr levels were significantly higher than those in control group(P＜0.01). The linear correlation analysis showed that the serum NO had a negative correlation between serum BUN and Cr level (P＜0.01). ConclusionThe patients with obstructive jaundice and renal dysfunction may lead to the decrease of serum NO level. NO may have some protective effects to the renal function during obstructive jaundice.
Objective To review the vascular anatomy of the donor and the reci pient for the l iving kidney transplantation. Methods The recent l iterature about the vessels of donor and reci pient in cl inical appl ications was extensively reviewed. Results The pertinent vascular anatomy of the donor and recipient was essential for the screening of the proper candidates, surgical planning and long-term outcome. Early branching and accessory renal artery of the donor were particularly important to deciding the side of nephrectomy, surgical technique and anastomosing pattern, and their injuries were the most frequent factor of the conversion from laparoscopic to open surgery. With increase of laparoscopic nephrectomy indonors, accurate venous anatomy was paid more and more attention to because venous bleeding could also lead to conversion to open nephrectomy. Multidetector CT (MDCT) could supplant the conventional excretory urography and renal catheter angiography and could accurately depict the donors’ vessels, vascular variations. In addition, MDCT can excellently evaluate the status of donor kidney, collecting system and other pertinent anatomy details. Conclusion Accurate master of related vascular anatomy can facil iate operation plan and success of operation and can contribute to the rapid development of living donor kidney transplantation. MDCT has become the choice of preoperative one-stop image assessment for living renal donors.
In this paper, systematic reviews, randomized controlled trials and other relevant studies on surgical and adjuvant therapy following operative therapy in renal cancer were identified by searching the Guidelines International Network, ACP Journal Club, the Cochrane Library （Issue 3, 2005 ） , MEDLINE, EMBASE and CBMdisc （ from 1996 to Sept. 2005）. In operative therapy, we found no study comparing operative therapy with no treatment or adjuvant therapy alone; A meta-analysis of cytoreductive nephrectomy in patients with metastatic renal cancer showed adjuvant therapy following nephrectomy was more effective than adjuvant therapy alone; a review comparing radical nephrectomy with nephron-sparing surgery in small-volume renal tumors found similar effectiveness between the two procedures. In the adjuvant therapy following nephrectomy, ten RCTs found adjuvant cytokine therapy （Interferon and Interleukin-2 ） and 5-FU not effective in the adjuvant setting, and could increase adverse reaction; Four RCTs found adjuvant vaccine therapy effective in the adjuvant setting with only a few side effects.
ObjectivesTo systematically review the efficacy and safety of laparoscopic pyelolithotomy (LP) versus percutaneous nephrolithotomy (PNL) in treating large (>2 cm) renal pelvic calculi.MethodsDatabases including PubMed, EMbase, Web of Science, The Cochrane Library, CBM, CNKI and WanFang Data were searched for relevant randomized controlled trials (RCTs) comparing LP with PNL for the treatment of large renal pelvic calculi from inception to September 23th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of eligible studies. Meta-analysis was then performed by using RevMan 5.2 software.ResultsFive RCTs with 447 patients were included. The results of meta-analysis showed that: compared with PNL group, LP group provided a significantly higher stone-free rate (RR=1.07, 95%CI 1.01 to 1.13, P=0.01), lower auxiliary procedure rate (RR=0.36, 95%CI 0.13 to 1.01, P=0.05), less hemoglobin decrease (MD=–0.83, 95%CI –1.05 to –0.61, P<0.000 01) and lower postoperative fever rate (RR=0.36, 95%CI 0.18 to 0.72,P=0.004). However, no significant differences were detected in conversion rate (RR=0.76, 95%CI 0.19 to 3.07, P=0.70), blood transfusion rate (RR=0.40, 95%CI 0.14, to 1.12, P=0.08), postoperative leakage rate (RR=1.87, 95%CI 0.67 to 5.21, P=0.23), operative time (MD=10.49, 95%CI –17.14 to 38.13, P=0.46) and hospital stay (MD=0.53, 95%CI –0.22 to 1.28, P=0.17).ConclusionsLP is superior to PNL with regard to stone-free rate, auxiliary procedure rate, hemoglobin decrease and postoperative fever rate. Due to limited quality and quantity of included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate factors such as renal injury grade （Sargent Method）, blunt or penetrative renal injury, injury severity score（ISS）, and shock influencing the need for operation or nephrectomy, and predictive of mortality in renal injury. Methods A well~tesigned questionnaire was used to collect medical records retrospectively. Two hundred and twenty-one cases of renal injury in West China Hospital from 1998 to 2002 were included, logistic regression analysis was used for multi-factors analysis. Results The average age of the 221 cases was 31.6, with 191 males （86.4%） and 30 females （13.6% ）, 175 blunt injuries （79.2%） and 46 penetrative injuries （20.8%）, and 101 concomitant injuries （45.7%）. Six cases died of renal injury （2.7%）. The results of logistic regression showed that the need of operation was related to injury grade, Type of renal injury, and shock significantly. ORs （odd ratios） were 5. 965 with 95% CI 2. 767 to 12. 859, 4. 667 with 95% CI 1. 725 to 12. 628, and 2. 547 with 95% CI 1. 684 to 3. 936 respectively. The need of nephrectomy was significantly related to injury grade with OR 11. 550 and 95% CI 4. 253 to 31. 366. The death was significantly related to ISS with OR 1. 263 and 95% CI 1. 082 to 1. 411. Conclusions The results of our data suggest the need of operation depends on injury grade, blunt or penetrative renal injury, and shock. The need of nephrectomy depends on injury grade. The death is related to ISS.
ObjectiveTo investigate the decision of combined liver and kidney transplantation (CLKT) after renal transplantation, provide surgical therapeutic experience for those patients with liver and renal insufficiencies and hepatorenal syndrome and summarize the risk factors, demerits and merits, and operative indications of CLKT.
MethodsThe data of three successful CLKT cases of our centre from Feb. 2014 to Jan 2015 were retrospectively analyzed, and these three patients had kidney transplantation before. We also reviewed the latest associated literatures.
ResultsThree patients got successful operations of CLKT and had very good recovery of renal function several days ofter operaton. Two of them discharged a few weeks after surgery, and one of these two patients got severe pulmonary infection of fungus two month after CLKT but recovered under proper therapy finally. The third patient died of severe mixed infection one month after CLKT.
ConclusionsThe surgical techniques and rejection are not the main impact factor to the prognosis of CLKT after renal transplantation. Infection is the biggest trouble to which we should pay most of our attention. We should decide whether to do synchronous or nonsynchronous CLKT according to the situation before surgery. Moreover, the systematic therapy administration after CLKT is very necessary for the patients' long-term survival.
ObjectiveTo evaluate the safety and efficacy of flexible ureteroscopic lithotripsy for renal stones of longer than 2 cm in diameter.
MethodsFrom August 2012 to July 2014, 15 selected patients with renal calculi of longer than 2 cm in diameter underwent flexible ureteroscopic lithotripsy with holmium laser by the same surgeon. Preoperative indwelling ureteral stent was performed for 1-2 weeks, and super smooth guidewire was inserted after checking and dilation of the ureter was performed with F8.0/9.8 rigid ureterosope. Flexible ureteroscope sheath was inserted through guidewire. Ureterosope was followed by flexible ureteroscope sheath. Larger stone fragments were removed by basket.
ResultsThe success rate of ureteroscopic insertion was 100% and no severe intraoperative complications occurred. The operation time ranged from 50 to 125 minutes averaging 75. No ureteral perforations or pyonephrosis or acute renal insufficiency occurred. Four patients had high fever after operation and improved after positive anti-infection treatment. After 2 days, the stone-free rate was 73.3% (11/15) by reviewing KUB. The follow-up of 4 weeks showed the stone-free rate was 86.7% (13/15). One case of stone fragments retained in the middle and lower ureter and the fragments were taken out by ureteroscopic lithotripsy. The other case of renal residual calculi was operated by flexible ureteroscope holmium laser lithotripsy in two stage.
ConclusionFlexible ureteroscopic lithotripsy is a favorable option for patients with renal stones of longer than 2 cm in diameter, especially for recurrent renal calculi.
Objective To evaluate the efficacy of mycophenolate Mofetil (MMF) and azathioprine (AZA) after renal transplantation. Method Searching: Medline, Embase, Cochrane library and Chinese Biomedicine database (CBM); identified the randomized controlled trials (RCTs) and applied Revman 4.11 for statistical analyses. Results Twenty-two RCTs were identified, involving MMF and AZA for anti-rejection after renal transplantation. The data shown that MMF (2 g/d) was more beneficial than AZA in improving the graft survival rate of short periods and the long-term patient survival rate, but there was no statistical differences between MMF (3 g/d) with AZA. Whether in 6 months or in 1 year after renal transplantation, the use of MMF (2 g/d) or MMF (3 g/d) could markedly reduce the incidence of biopsy-proven rejection. Conclusions Comparing with AZA, MMF is a more potent immunosuppressive drug, and more efficient in reducing the acute rejection after renal transplantation. MMF can improve the graft and patient survival rate. The 2 gram per day is more acceptable.
Rheumatoid arthritis (RA) is one of the most common chronic inflammatory diseases. It mainly involves joints, as well as extra-articular organs. The extra-articular manifestations (EAM) are more common in patients with severe active disease, and the mortality of RA patients with EAM is 2.5 times of RA patients without EAM. Renal damage is rare in EAM, which mainly includes renal damage associated with RA itself, renal amyloidosis, and drug-induced secondary renal damage. In recent years, researches on RA renal damage have gradually increased, and mainly focused on therapy and prognosis. The recent research progress of RA renal damage are summarized in this review.
Objective To assess the cost-utility study of renal transplantation compared with nemodialysis (HD) and peritoneal dialysis (PD). Methods A prospective study of end-stage renal disease patients was followed up for 3 months after renal replacement therapy. The study population included 196 patients (renal transplant [RT] n=63, hemodialysis [HD] n=82 and continious ambulatory peritoneal dialysis [CAPD] n=51) from 6 hospitals of Sichuan province. Health-related quality of life was assessed by using the WHOQOL-BRIEF questionnaire. Utility scores were obtained so as to conduct CUA (cost-utility analysis). Costs were collected from financial department and by patient interview. Results The utility values were 0.539 9± 0.013 for RT, 0.450 8± 0.014 for HD, 0.512 2±0.099 for CAPD, respectively. The mean direct cost of the first three months of renal transplant was significantly higher than dialysis (RT and CAPD). Over 3 months, the average cost per quality-adjusted life year (QALY) for patients after CAPD was lower than HD and RT. Compared to HD, incremental cost analysis showed that CAPD was more ecnomical than RT. Sensitive analysis showed that CAPD was more effective than RT when ΔQALY varied in the limit of 95% confidence interval. However, the cost-utility of RT vs HD and CAPD vs HD was varied with ΔQALY level. Conclusions Cost-utility analysis showed that CAPD was a more favorable cost-utility ratio when compared to RT at early stage RT vs HD and CAPD vs HD, but which cost-utility ratio is better, we can not draw a certain conclusion.
