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F Vigués

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Evaluation of renographic and metabolic parameters in human kidney transplantation.

BACKGROUND: The aim of this work is to demonstrate that the value of the mean transit time (MTT) obtained from the 99mTc-MAG3 renogram deconvolution is related to the levels of adenine nucleotides determined in cortical biopsies from transplanted kidneys. METHODS: The functional state was estimated by means of the MTT and the initial height (H0) of the renal retention function obtained from the 99mTc-MAG3 renogram deconvolution and by the measure of adenine nucleotides obtained from biopsies. We studied 30 kidney graft recipients, 25 normal functioning grafts (NFG) and 5 with acute tubular necrosis (ATN). RESULTS: The MTT is significantly longer for ATN (p < 0.001). The initial uptake values (H0) are significantly lower for ATN (p < 0.001). The sum of adenine nucleotides (SAN) is significantly greater for NFG than for ATN (p < 0.001). The values of the MTT seem to reflect the energy state of the cells in transplanted kidney. CONCLUSION: The analysis of MTT may be indicative of the functional metabolic recovery and thus it may be predictive of the renal graft function at least in the same extent than the biochemical analysis of a cortical renal biopsy immediately after blood reperfusion of the tissue.

Adenine Nucleotides

Renal angioscopy.

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Effect of different preservation solutions on adenine nucleotide content and metabolism in human kidney transplantation.

Differences in purine metabolism produced by three preservation solutions were studied by determining the adenine nucleotide (ATP, ADP, AMP, and IMP) and nucleoside (adenosine, inosine, and hypoxanthine) levels in human kidney cortical biopsies. Forty kidney allografts were studied using University of Wisconsin (UW) solution (n = 20), Euro-Collins (EC) solution (n = 12), and modified EC solution with mannitol (M; n = 8). No significant differences were found between the three solutions studied with regard to ATP, ADP, or AMP changes. The mean ATP level (nmol/mg prot +/- SEM) at the end of preservation in the UW group was 2.7 +/- 0.3 nmol/mg, in the EC group 3.8 +/- 0.7 nmol/mg, and in the M group 2.3 +/- 0.4 nmol/mg. ATP 30 min after reperfusion in the UW, EC, and M groups was 5.7 +/- 0.8 nmol/mg, 6.4 +/- 1.0 nmol/mg, and 4.6 +/- 0.5 nmol/mg, respectively. However, an important difference appeared in the catabolic products determined. Kidneys perfused with UW solution had a significantly higher level of adenosine (2.6 +/- 0.6 nmol/mg), inosine (11.8 +/- 2.2 nmol/mg), and hypoxanthine (18.1 +/- 2.1 nmol/mg) at the end of cold storage than those perfused with EC (0.4 +/- 0.1 nmol/mg, 2.0 +/- 0.8 nmol/mg, and 7.1 +/- 1.4 nmol/mg) and M solutions (0.2 +/- 0.05 nmol/mg, 0.5 +/- 0.1 nmol/mg, and 5.2 +/- 0.6 nmol/mg; P < 0.05). These levels returned to initial values 30 min postreperfusion and there were no differences with the EC or M solution groups at that time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenine Nucleotides

Assessment of purine metabolism in human renal transplantation.

Cortical levels of nucleotides and their degradation products from 42 transplanted human kidneys have been studied. Biopsies were performed during renal harvesting just before cooling, at the end of cold storage, and following reinstallment of renal blood circulation. ATP levels fell, and AMP and degradation products (inosine monophosphate [IMP], inosine, adenosine, and hypoxanthine) increased during cold storage and returned to near-normal values 30 min after recirculation. The major degradation product found was hypoxanthine, indicating very poor xanthine oxidase activity in human kidneys. The sum of adenine nucleotides (ATP+ADP+AMP) did not significantly decrease after cold storage, but adenylate energy charge (ATP+1/2ADP/ATP+ADP+AMP) was reduced to half, being recovered in implanted kidneys. The sum of adenine nucleotides was significantly reduced after implantation. The rate of acute tubular necrosis was higher in kidneys preserved for more than 30 hr. Kidneys with acute tubular necrosis had significantly lower levels of the total pool of adenine nucleotides at reperfusion, but there was no correlation between incidence of acute tubular necrosis and ATP or other metabolite levels in the kidneys before or during cold preservation. The success of human kidney transplantation does not seem to depend only on the pool of residual nucleotides at the end of cold storage but on other factors that determine the ability of the cell to recover a normal energy state after reperfusion.

Adenosine

[Hormonal treatment of cancer of the prostate].

We set forth the results obtained after application of a hormonal protocol in prostate carcinoma (P.C.) on 257 patients controlled between June 1976 and June 1987, of whom we have selected 160 who fulfilled the following requirements: under 80 years old, confirmed anatomopathological diagnosis, state equal to or above the T1 of the Union International contre le Cancer (U.I.C.C.) classification, tolerance of treatment applied, clinical, analytical and complete, systematic iconographic follow up and minimum survival of more than one year. We treated those patients with localised P.C. (they have no demonstrable metastases), who in our series numbered 78 (78/160), with Diethylethylbestrol (D.E.S.) at an orally administered dose of 1 mgr. a day. In these the plasma testosterone dropped below 100 nanograms/l. in 57 cases (57/79). In this case metastases appeared in 22 cases (22/78). We treated those patients with metastatized P.C., who in our series numbered 59 (59/160), with orally administered Estramustine Phosphate (Estracyt) at a dose of 560 mgr. every 24 h. in two goes. In these the plasma testosterone dropped below 100 nanograms/l. in 50 cases (50/59). In this group the metastases disappeared in 7 patients, became stabilized in 30 and worsened in the other 22 patients. We carried out surgical orchiectomy on 49 patients (49/160): in 17 cases due to associate vascular pathology, in 13 cases for sociocultural reasons, in 5 cases because of advanced age and in 14 cases it was conducted on patients with a poor response to D.E.S.

Adenocarcinoma

[Spontaneous subcapsular hematoma. Report of 4 new cases].

The Spontaneous Subcapsular Hematoma is an uncommon entity. In most cases it develops on a pathological kidney or in patients with coagulopathy. In the pathology reviewed we found a high index of tumoural pathology. We present 4 cases of Spontaneous Subcapsular Hematoma received in our service. As opposed to other series, in none of our patients could tumoural pathology be attributed as the primary cause of the hematoma.

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