Presence Of Acute Tubular Necrosis Research Articles

AN ASSESSMENT OF INTRARENAL HYDROSTATIC PRESSURE MEASUREMENTS IN THE DIAGNOSIS OF ACUTE RENAL ALLOGRAFT REJECTION

Postoperative intrarenal pressure measurements may be an aid to the diagnosis of acute renal transplant rejection, especially in patients treated with cyclosporine. Serial measurements of intrarenal pressure were made in 38 recipients using a fine-needle technique. Thirty-two intraoperative and 207 postoperative measurements were made, and 39 clinical rejection episodes (23 confirmed by biopsy) monitored. Intraoperative pressures in grafts with immediate function (37.4 +/- 4.0 mmHg, mean +/- SEM) were not significantly different from those with delayed function (30.9 +/- 4.8 mmHg), whereas postoperative pressures were greater (P less than 0.01) in kidneys with acute tubular necrosis (29.4 +/- 1.9 mmHg) than in functioning grafts (20.4 +/- 0.9 mmHg). Pressures recorded during clinical rejection episodes (44.3 +/- 2.3 mmHg) exceeded (P less than 0.001) those during quiescent periods (23.6 +/- 1.0 mmHg). During rejection episodes, higher pressures (P less than 0.01) were recorded from tender or palpably enlarged grafts (52.5 +/- 3.0 mmHg) than in the absence of these signs (36.3 +/- 3.1 mmHg), and patients whose transplants biopsies showed cellular rejection tended to have greater pressures (50.1 +/- 4.1 mmHg) than those with concomitant vasculopathy (36.4 +/- 3.9 mmHg), but the latter did not reach statistical significance. In 7 cases of cyclosporine toxicity the intrarenal pressure was 17.8 +/- 4.2 mmHg. Using a diagnostic cut off point of 40 mmHg, the investigation failed to recognize 26% of acute rejection episodes--and, in the presence of acute tubular necrosis, it wrongly categorized 21% of nonrejectors. While its predictive capacity was limited, the test may occasionally be helpful in the differentiation of cyclosporine toxicity and rejection in functioning kidneys.

Factors influencing the long term functional success rate of human renal allografts.

A review of 101 renal allografts treated in similar fashion was carried out utilizing actuarial tables to calculate the incidence of success at intervals following transplantation. This study revealed that renal functional success stabilized at 18 months following surgery at rates of 55% and 34% in related living donor and cadaveric donor recipients respectively. Four groups of patients were distinguished by their clinical course having long-term success rates after having survived the first four months of 100, 84, 50, and 29 per cent. The presence of acute tubular necrosis did not alter prognosis, whereas rejection episodes occurring within the first week, or after the first four months, and persistent proteinuria were associated with a success rate of less than 30%. It is suggested that clinical grouping reflects closely the underlying histocompatibility difference.