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Controversy in organ preservation.

Renal preservation has contributed to improvements in human cadaver kidney transplantation in terms of viability testing and logistics. Unfortunately, the antigenicity of a kidney has not been reduced by our present preservation methods; consequently, immunologic problems in cadaver kidney transplantation still remain. Simple cold storage is an acceptable method for kidneys subjected to minimal warm ischemia. It can be used where anticipated storage time will not exceed 10 to 15 hours. Pulsatile or nonpulsatile machine perfusion will give better results especially when kidneys have sustained up to 60 minutes warm ischemia. Where there is also a need for storage time longer than 15 hours, perfusion should be used. Cryoprecipitated millipore-filtered plasma remains the most commonly used perfusate. Preservation really begins before the harvesting. Present preservation techniques cannot revive a dying kidney. No single test will determine the degree of viability of a kidney. A systematic multidisciplinary effort is needed to augment our understanding and knowlege about the effect of hypothermia on organs. Hopefully these efforts will result in the development of an organ bank whereby many more kidneys will be available for transplantation.

Animals↗

[Pharmacokinetics and nephrotoxicity of aluminum in rats of various ages].

Experiments were done in 5-, 10-, 20-, 33-, 55-, and 105-d-old rats to clarify whether or not age-dependent differences in pharmacokinetics and nephrotoxicity of Al exist. Using kidney function tests distinct signs of alumina (Al) nephrotoxicity can be demonstrated following 1 or 2 mg Al/100 g b. wt. i.p.: polyruria, reduced concentration of sodium in urine, elevated blood urea nitrogen concentrations. There is the same degree of nephrotoxicity both in adult and in young rats with an immature kidney function. Following administration of 2 mg Al/100 g b. wt. i. p. the initial plasma concentration of Al is distinctly lower in young than in adult rats. A rapid phase of elimination of Al from plasma (alpha-slope) is absent in 5-d-old rats and fully expressed in 33- and 55-d-old rats. In young rats the relative volume of distribution of Al is smaller than in adults. Following the administered dose nephrotoxicity in ducing concentrations of Al were obviously reached also in kidney tissue of young rats.

Aging↗

Anticoagulation therapy for renal insufficiency after burns.

The changes in blood coagulation, fibrinolysis and kidney function and the effect of anticoagulation therapy using herapin were investigated in rabbits with full thickness skin loss burns covering 35 per cent of the total body surface area. Determinations of various kidney function tests, blood coagulation and fibrinolysis tests, blood viscosity and haematocrit values were made before burning and after 8 and 24h. Thirty rabbits were divided into a non-therapy group, an intravenous infusion group, a heparin group, an antithrombin III group and an antithrombin III plus heparin group and the results were compared. Oliguria and a disturbance of kidney function were noted 8 h after the burn in the non-therapy group. In the intravenous infusion group urine volume was well maintained although the early stage of non-oliguric renal insufficiency was noted. The changes noted in the intravenous infusion group were prevented almost completely in the heparin group but FENa and CH2O were elevated at 24h probably because antithrombin III activity was markedly depressed. In the antithrombin III group and the antithrombin III plus heparin group, however, creatinine clearance (Clcr) was moderately elevated while FENa and CH2O remained unchanged as compared with the values before the burn. The antithrombin III plus heparin group showed slightly better results than the antithrombin III group in Ucr/Pcr ratio, Clcr and CH2O. The results of the present study indicate that it is extremely effective to initiate appropriate fluid therapy immediately after a burn and to administer antithrombin III concentrate in combination with or without heparin for the prevention of acute renal insufficiency in patients with a severe burn.

Acute Kidney Injury↗

[A new test selectively characterizing specific kidney function].

The effect of total x-ray irradiation on distribution and elimination of 51Cr cations was studied on 60 white noninbred rat males. The radionuclide was introduced intragastrically and intravenously 0.5-1 hour after the irradiation. Chromatographic and spectrophotometric investigation of the marker was performed in the serum and urine. It was established that Cr3+ is absorbed from the gastrointestinal tract by means of facilitated diffusion with glutamine as the carrier. Its urinary excretion reflects proportionally the degree of developing acidosis and selectively the process of chromium glutaminate deamidation in the kidneys. It is suggested to determine urinary Cr3+ elimination as a new test instead of using ammonia which is produced both by deamidation and deamination.

Animals↗