Machanism of Progresses renal disease studied by a magnifying-endoscopy

我们通过放大内窥镜开发了一种肾脏微循环的直接成像系统，使红细胞在肾小球和皮质小管周围毛细血管（CPC）中的运动可视化。我们研究了活体和尸体供肾移植早期CPC微循环的变化。对20例肾移植患者在再灌注后20、60、90和120分钟的CPC红细胞速度进行了监测和测量。移植肾来自11名活体供体和9名不跳动的尸体供体。在活体供体移植中，血运重建后20分钟CPC红细胞速度下降到肾切除前基线值的三分之一，再灌注后120分钟恢复到肾切除前的水平。相比之下，在尸体供体移植中，它持续受到90分钟的干扰。血运重建术后20 ~ 60分钟，尸体移植的CPC红细胞速度比活体移植的CPC红细胞速度恶化更为明显。在活体供体移植中，红细胞速度与供体年龄、热缺血和冷缺血时间、初尿时间和最佳肌酸清除率无关。在尸体移植的缺血时间，WIT和CIT与红细胞速度无关。然而，供者年龄、ATN持续时间和移植后最佳肌酸清除率与红细胞速度显著相关。CPC红细胞速度的测定是预测同种异体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.