Matteucci E, Carmellini M, Bertoni C, Boldrini E, Mosca F, Giampietro O
Istituto di Clinica Medica II, University of Pisa, Italy.
Ren Fail. 1998 Mar;20(2):325-30. doi: 10.3109/08860229809045118.
Post-reperfusion inflammation as well as anti-allograft response occur following kidney transplantation. We evaluated tissue damage by multiple renal indicators and searched for rejection predictors forewarning serum creatinine upturns. Twenty recipients (43 +/- 9 y; donors' age 35 +/- 16 y) of first renal grafts were studied. All through their hospital stay (35 +/- 18 d, range 17-75 d) we measured serum levels of urea, creatinine and electrolytes along with urinary excretion rates of total protein, albumin, enzymes (GGT, NAG, AAP) and electrolytes. During the period of observation, peaks were seen on the 1st day for serum creatinine, serum K+ and urine albumin output; on the 2nd day for urine Na+, GGT, AAP and protein excretion rates; on the 4th day for urea and creatinine outputs; on the 5th day for NAG output. On the 14th day, serum urea and creatinine as well as urine GGT, NAG, AAP, albumin and total protein were still elevated compared to 20 healthy control subjects. Delayed/slow graft function was observed in six recipients with higher pre-transplantation plasma lipids and lower donor HDL cholesterol. Hospital stay time was correlated with need for post-transplantation dialysis (p = 0.01) and recipient proteinuria by time 0 (TO) to day 3 (p = 0.02). Cold ischemia time was positively associated with 0-3 d serum creatinine, 0-3 d urinary urea and protein outputs (multiple r 0.9, p < 0.001). Multivariate analysis of longitudinal data showed that recipients' serum creatinine was positively correlated (p < 0.001) with urine AAP and negatively correlated with urine albumin, with diuresis volume and urine creatinine (p < 0.01). Serum creatinine elevations were preceded (previous 1-7 d) by increases in urinary indicators, the probability being higher in the presence of multiple simultaneous abnormalities. Useful parameters predictive of favorable graft outcome prior to transplantation included a brief cold ischemia time and a normal donor/recipient serum lipoprotein profile. Following transplantation, useful parameters were a high diuresis volume at time zero along with low urine NAG and high albumin outputs; early (first opst-graft 3 d) polyuria, low urea and GGT, high K, NAG and total protein excretions.
肾移植后会发生再灌注炎症以及抗移植反应。我们通过多种肾脏指标评估组织损伤，并寻找预测血清肌酐升高的排斥反应指标。对20例首次接受肾移植的受者（年龄43±9岁；供者年龄35±16岁）进行了研究。在他们住院期间（35±18天，范围17 - 75天），我们测量了血清尿素、肌酐和电解质水平，以及尿中总蛋白、白蛋白、酶（γ-谷氨酰转移酶、N-乙酰-β-D-氨基葡萄糖苷酶、碱性磷酸酶）和电解质的排泄率。在观察期间，血清肌酐、血清钾离子和尿白蛋白排出量在第1天出现峰值；尿钠离子、γ-谷氨酰转移酶、碱性磷酸酶和蛋白排泄率在第2天出现峰值；尿素和肌酐排出量在第4天出现峰值；N-乙酰-β-D-氨基葡萄糖苷酶排出量在第5天出现峰值。在第14天，与20名健康对照者相比，血清尿素和肌酐以及尿γ-谷氨酰转移酶、N-乙酰-β-D-氨基葡萄糖苷酶、碱性磷酸酶、白蛋白和总蛋白仍升高。6名移植前血浆脂质较高且供者高密度脂蛋白胆固醇较低的受者出现了移植肾功能延迟/缓慢。住院时间与移植后透析需求（p = 0.01）以及0时（T0）至第3天受者蛋白尿（p = 0.02）相关。冷缺血时间与0 - 3天血清肌酐、0 - 3天尿尿素和蛋白排出量呈正相关（复相关系数0.9，p < 0.001）。对纵向数据的多变量分析表明，受者血清肌酐与尿碱性磷酸酶呈正相关（p < 0.001），与尿白蛋白、尿量和尿肌酐呈负相关（p < 0.01）。血清肌酐升高之前（前1 - 7天）尿指标会升高，同时出现多种异常时这种可能性更高。移植前预测移植结果良好的有用参数包括短暂的冷缺血时间和供者/受者血清脂蛋白谱正常。移植后，有用的参数包括0时尿量高、尿N-乙酰-β-D-氨基葡萄糖苷酶低和白蛋白排出量高；早期（移植后第1 - 3天）多尿、尿素和γ-谷氨酰转移酶低、钾、N-乙酰-β-D-氨基葡萄糖苷酶和总蛋白排泄高。
