Renal functions of nine patients with homotransplanted kidney from living donors were consecutively examined during the period of two months after the operation.
As parameters of tubular function, excretion fraction of filtered sodium (EF
Na) and urine-plasma ratio of creatinine (U/P
cr) were determined as well as clearances of creatinine (C
cr) and para-aminohippurate (C
PAH).
The following results were obtained as a common functional change of the transplanted kidneys during the period of early Renal functions of nine patients with homotransplanted kidney from living donors were consecutively examined during the period of two months after the operation.
As parameters of tubular function, excretion fraction of filtered sodium (EF
Na) and urine-plasma ratio of creatinine (U/P
cr) were determined as well as clearances of creatinine (C
cr) and para-aminohippurate (C
PAH).
The following results were obtained as a common functional change of the transplanted kidneys during the period of early rejection.
The earliest change of kidney function was manifested as a reduction of EF
Na (less than 2%) and increase of U/P
cr (more than 20) which appeared simultaneously with the general clinical signs such as fever and leucocytosis. However, these changes had no relationship with the severity of the rejection.
As EF
Na and U/P
cr were restored to the previous levels, urine flow decreased abruptly and an elevation of BUN, acidosis, and decrease of C
cr and C
PAH appeared as well.
During the oliguric period continuing for 3 to 8 days, EF
Na increased as a rebound and U/P
cr decreased reciprocally. In spite of immuno-suppressive therapy, these changes as well as azotemia and lowered clearances advanced markedly even for several days after the cessation of oliguric phase.
When recovery of these functional changes initiated, urine volume was still increasing and reached its peak several days later.
Functional recovery was observed relatively rapidly with a slight delay in urine flow, EF
Na and acidosis.
In accord with the reduction of the EF
Na, a tendency of hyponatremia and hypochloremia which disappeared after the oliguric phase was noted. When acidosis was present in the polyuric phase, hyperchloremia was concomitantly recognized.
Reduction of EF
Na and increase of U/P
cr have been reported in stenosis of the renal artery, thrombosis of the renal vein or stricture of the ureter. However it is not so difficult to differentiate the early rejection from these diseases, since there is a difference in the variation pattern of EF
Na and U/P
cr after the initial change.
It may be concluded that determination of the EF
Na and U/P
cr is highly significant for detection of the earliest sign of early rejection, evaluation of the effect of immuno-suppresive therapy and differential diagnosis of oliguria which occur in the homotransplanted kidney.
View full abstract