Zhilin Nie

Kidney injury molecule-1 (KIM-1): a novel kidney-specific injury molecule playing potential double-edged functions in kidney injury

Kidney injury molecule-1 (KIM-1), a recently discovered transmembrane protein, is expressed in dedifferentiated proximal renal tubular epithelial cells in damaged regions. It may participate in the progress of renal injury or repair. Many studies have illustrated the different functions of KIM-1 in various renal diseases including protective functions in acute kidney injury and damaging functions in chronic kidney disease. Although, the exact functions of KIM-1 still remain unclear, some scientists speculate that KIM-1 is expected to be a therapeutic target for kidney injury. In this review, some of the known features and functions of KIM-1 are highlighted.

Urological Complications in 1,223 Kidney Transplantations

Introduction: Urological complications after kidney transplantation may lead to graft loss. In this study, we retrospectively reviewed urological complications in 1,223 kidney transplantations that were performed at our institution. Materials and Methods: The occurrence of urological complications such as urine leakage, ureteral obstruction and vesicoureteral reflux (VUR) according to the different way of urinary tract reconstruction, ureteroneocystostomy (U-C) and ureteroureterostomy (U-U), was studied. Results: Urological complications were encountered in 92 (7.5%) cases, including urine leakage (n = 43, 3.5%), ureteral obstruction (n = 35, 2.9%) and VUR (n = 14, 1.1%). 75 cases (7.9%) were in the U-C group and 17 cases (6.2%) in the U-U group. 91 recipients were successfully treated, and 1 patient lost the graft due to kidney pelvis and ureteral necrosis. There was no recipient loss due to these complications. For recipients with urological complications, the 1- and 3-year survival rates were 90 and 88% for recipients and 87 and 82% for grafts, respectively. Conclusions: After U-U, the same number of overall incidences of urological complications is observed as after U-C; however, a decrease in the number of incidences of urine leakage is apparent. Therefore, U-U is a good first option with a greater success rate of resolving ureteral stenosis with endourology and no risk of VUR.

Treatment of Urinary Fistula After Kidney Transplantation

Urinary fistula is a common complication after kidney transplantation and may lead to graft loss and patient death. Its current incidence ranges from 1.2% to 8.9%. From December 1993 to April 2007, 1223 kidney transplant procedures were performed by our kidney transplantation team. In 948 recipients (group 1), we performed an extravesical ureteroneocystostomy, and in 275 recipients (group 2), a terminoterminal ureteroureterostomy (UU). We observed urinary fistulas in 43 patients (3.5%), with mean onset at 6 days (range, 3-20 days) posttransplantation. Urinary fistula was significantly more common in group 1 compared with group 2 (4.1% and 1.5%, respectively; P < .05). The distal ureteral necrosis was the major frequent cause of urinary fistula (n = 34; 76.7%), which required either a second ureteroneocystostomy or UU using the native ureter. Of these 21 fistulas, including 10 recurrent fistulaes, were successfully treated with pedicled omentum covering the anastomotic stoma. Conservative treatment with a stent and Foley catheter drainage for 1 to 2 weeks was successful in 8 patients. All patients with a urinary fistula regained normal graft function except 1 in whom transplant nephrectomy was necessary because of pelvic and ureteral necrosis. There was no recipient loss secondary to urinary fistula. In conclusion, UU can decrease the incidence of urinary fistula after kidney transplantation. Most urinary fistulas require surgical management; and pedicled omentum is useful to repair the fistula.

Comparison of urological complications with primary ureteroureterostomy versus conventional ureteroneocystostomy

Nie Z, Zhang K, Huo W, Li Q, Zhu F, Jin F. Comparison of urological complications with primary ureteroureterostomy versus conventional ureteroneocystostomy.
Clin Transplant 2009 DOI: 10.1111/j.1399‐0012.2009.01134.x
© 2009 John Wiley & Sons A/S.

Acute Femoral Neuropathy Following Renal Transplantation: A Retrospective, Multicenter Study in China

BACKGROUND We investigated the relationship between the mode and duration of iliac artery anastomosis and acute femoral neuropathy (AFN). METHODS A retrospective analysis was performed for 83 AFN cases from 6 transplantation centers in China. The incidence and nature of dysfunction of AFN were classified based upon the duration of iliac arterial anastomosis. No prisoners were used, and no organs from prisoners were used to obtain the data. RESULTS The incidence of AFN was 3.6% (53/1,449) in internal iliac anastomosis (group 1), 3.1% (11/346) in external iliac anastomosis (group 2) (P > .05 vs. group 1), and was 54.2% (19/35) in internal iliac ligation with external iliac anastomosis (group 3 P < .01 vs. groups 1 and 2). In group 1, the duration of the arterial anastomosis was <or=20 minutes in 1 case (1.9%), and >20 minutes in 52 cases (98.1%). In group 2, the duration of arterial anastomosis was <or=20 minutes in 1 case (9.0%) and >20 minutes in 10 cases (91%). In group 3, the duration of the arterial anastomosis was >20 minutes in all cases; 20 cases showed injury to the iliolumbar or deep iliac circumflex artery. CONCLUSION The incidence of AFN was associated with the selection of iliac arteries, the duration of the arterial anastomosis, and an injury to the iliolumbar or deep iliac circumflex artery.

Diagnosis and Treatment of Hyper-Delayed Graft Function after Renal Transplantation

Background: Renal transplant recipients may experience delayed graft function (DGF), but recovery can take many months, a condition we define as hyper-delayed graft function (HDGF). Methods: A retrospective review of 50 renal transplant recipients who had HDGF and comparison with patients who had immediate graft function (IGF) and DGF. Results: Acute renal tube necrosis (ATN) during or soon after surgery was the most common cause of HDGF. Following standard treatment, 48 HDGF patients transitioned from oliguria to polyuria in 45 days (± 3) and renal function of the kidney fully recovered in 73 days (± 1). These HDGF patients had similar overall survival and kidney survival rates as IGF and DGF patients who were matched for age, sex, primary underlying disease, tissue matching, warm and cold ischemia time, and surgery time. Conclusions: Appropriate care and monitoring of HDGF patients allows them to regain normal renal function and to achieve patient and renal survival rates similar to those of IGF and DGF patients.

Surgical Management of Intractable Chyluria: A Comparison of Retroperitoneoscopy with Open Surgery

Background: Retroperitoneoscopic renal pedicle lymphatic disconnection has been described in the management of intractable chyluria. Methods: We retrospectively reviewed the clinical outcomes of 76 patients with intractable chyluria undergoing renal pedicle lymphatic disconnection via a retroperitoneoscopic (n = 59) or conventional open approach (n = 17). Operative time, intraoperative blood loss, volume of postoperative drainage, postoperative draining time, postoperative intestinal recovery, intraoperative and postoperative complications, and postoperative hospital stay were evaluated. Results: Compared with open surgery, retroperitoneoscopy was superior in terms of operative time, intraoperative blood loss, postoperative drainage, postoperative draining time, postoperative intestinal recovery time, and postoperative hospital stay. Recurrence developed in 2 patients due to the contralateral chylous efflux confirmed by cystoscopy during the period of 9–85 months of follow-up. Conclusions: With minimal invasion, sparing operative time, less blood loss, and rapid recovery, retroperitoneoscopic renal pedicle lymphatic disconnection can achieve at least the same clinical efficacy as open surgery.

Pedicled greater omentum graft: A possible approach for reducing the incidence of urinary fistula after kidney transplantation

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