Machanism of Progresses renal disease studied by a magnifying-endoscopy

我们通过放大内窥镜开发了一种直接的肾脏微循环成像系统，能够显示肾小球和肾小管周围毛细血管(CPC)中红细胞的运动。我们研究了活体和身体供体移植肾早期CPC的微循环。对20例肾移植患者于再灌注后20、60、90、120分钟监测CPC中的红细胞运动速度。移植的肾脏来自11名活体捐赠者和9名非心脏跳动的身体捐赠者。活体供肾移植血运重建后20min，CPC内红细胞流速降至肾切除前的1/3，再灌注120min后恢复至肾切除前的水平。相比之下，在身体捐赠者移植中，它继续被干扰90分钟。在血运重建后20~60分钟，身体移植的CPC的红细胞速度比活体移植的更明显。活体供者的红细胞速度与供者的年龄、热缺血和冷缺血时间、首次排尿时间和最佳肌酸清除时间无关。在身体移植中，WIT和CIT的缺血时间与红细胞运动速度无关。而供者年龄、ATN持续时间和移植后最佳肌酸清除与移植后的红细胞速度显著相关，测定CPC中的红细胞速度是预测移植肾长期缺血后肾功能恢复和保留肾功能的可靠方法。

We developed a direct imaging system of renal microcirculation by a magnifying-endoscopy enabling visualization of the movement of erythrocyte in glumerular and cortical peritubular capillary(CPC). We investigated the microcirculation of CPC in the early phase of both living and cadaveric donor transplant kidneys. Erythrocyte velocity in CPC were monitored and measured in twenty renal transplants at 20,60,90 and 120 minutes after reperfusion. The kidney grafts came from 11 living donors and 9 non-heart beating cadaveric donors. In living donor transplants, erythrocyte velocity in CPC at 20 minutes after revascularization declined to one third of base line value just before nephrectomy, and recovered to the pre-nephrectomy value 120minutes after reperfusion. In contrast, it continued to be disturbed for 90 minutes in cadaveric donor transplants. Erythrocyte velocity in CPC more significantly deteriorated in cadaveric transplants than in those of living transplants at 20 through 60 minutes after the revascularization.In living donor transplants, erythrocyte velocity did not correlate with donor age, both warm and cold ischemic time, time to the initial urination and best creatine clearance. In the cadaveric transplants ischemic time, both WIT and CIT, did not correlate with the erythrocyte velocity. However, donor age, duration of ATN and best creatine clearance after transplantation significantly correlated with the erythrocyte velocity.The measurement of erythrocyte velocity in CPC is a reliable method for predicting the recovery of renal function and reserved renal function of kidney allografts undergoing prolonged ischemia.