| Allograft renal transplantation is the most important method to treat end-stage renal failure. Acute rejection (AR) was a major determinant of chronic allograft dysfunction and graft survival. The hypothesis that stable mixed chimerism imparts immunologic tolerance to kidney transplants was to be tested. This study assessed the ability of ultrasonography and radionuclide imaging in diagnose in AR and the role of chimerism in inducing immunologic tolerance.From the application of Doppler ultrasonography and radionuclide imaging in the complications of renal transplantation, we could easily diagnose the complications of renal artery stenosis, renal arteriovenous thrombosis, et al. But the diagnosis and differential diagnosis of AR, acute tubular necrosis and cyclosporine nephrotoxic were still difficult. In this study, ultrasonography and radionuclide imaging was used to evaluated the value in the diagnosis of the three complications above, especially the combination of two examinations in diagnosing AR.Between January 2001 and December 2002, 113 kidney transplants were performed at the China-Japan Union Hospital of Jilin University. All the patients were divided into 5 groups according to the recovering condition. 1.Normal transplantation group(n=75), 2.Acute rejection group(AR)(n=22), 3.Acute Tubular Necrosis group(ATN) (n=8), 4.ATN with AR group (n=3), 5.Cyclosporine Nephrotoxic (n=5). All the patients were observed by ultrasonography and radionuclide imaging in the next day to the operation. When serum creatinine decreased to normal, Series examinations were done in the 7 day and the 14 day. When serum creatinine or clinical sign became worse, the ultrasonography was done immediately and repeated every other day. Observing targets were, 1.Renal volume, 2.Echo of cortex and medulla and corticomedullary differentiation, 3.Echo of sinus, 4.Dilation or not in ureter, 5.RI, 6.Blood velocity of main renal artery. The first radionuclide imaging examination were performed in the first 48 hours, and three times per week. Observing targets were, 1.Record dynamic imaging of kidney and bladder to draw renogram, 2.TAC. A grading system was used. 0=normal renogram, 1=normal uptake, reduced excretion, 2=normal uptake, flat excretion curve, 3=rising curve, 4=reduced rate of uptake, rising curve and reduced absolute uptake, 5=minimal uptake.When one of the four following conditions appeared, we could directly diagnose AR. 1.RI>0.85, 2.Part of no echo area in renal cortex, 3.Renal volume enlarging more than 50%, 4.Loss of sinus echo. The cut-off levels for rejection were set at RI>0.75, sensitivity and specificity was 80% and 98.86%, misdiagnosis rate was 1.14% and rate of missed diagnosis was 20%, positive predictive value was 95.23%, predictive value of negative test was 94.57%. We could predict AR by ultrasonography and its sensitivity was 76.92%. RI is less 0.75 in both ATN and CN, therefore we could exclude ATN and CN by RI. Radionuclide imaging of AR belongs to grade 5, and its stage of recovery belongs to grade 4. Radionuclide imaging of ATN belongs to grade 2, and its stage of recovery belonged to grade 1. If grade 3 was found after grade 1 or 2, we ought to pay attention to AR during ATN. There was of no use in diagnosing CN by radionuclide imaging. The value of radionuclide imaging in AR showed that: sensitivity 88%, specificity 98.86%, misdiagnosis rate 1.14%, rate of missed diagnosis 12%, positive predictive value 95.65%, predictive value of negative test 96.67%. To improve the value of in diagnosing AR, two kinds of examinations were combined. We find that sensitivity was 92%, specificity 97.73%, misdiagnosis rate 2.28%, rate of missed diagnosis 8%, positive predictive value 92%, predictive value of negative test 97.73%.Either ultrasonography or radionuclide imaging could be used in diagnosing AR, and we could improve the value of diagnosis by combining the two examinations. We should make an examination of pathology in order to confirm the diagnosis when only one examination clues to AR. E...
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