| Renal transplantation is an effective method to treat end-stage renal disease(ESRD), but the rejection and various kinds of complications often result in functional impairment of the transplanted kidney. The problem that if the rejection of transplanted kidney have happened is intensively concerned in clinic. At present, there are many indexes judging the rejection, such as blood biochemistry, clinical observation, bloodstream parameter of color Doppler ultrasound and renal needle biopsy etc.Contrast comparative study is carried out in 91 patients with transplanted kidney who are taken the examination of both Color Doppler Flow Imaging (CDFI) and renal needle biopsy. These cases contain male 73, female18,whos -e ages are from 17 to 63. The average age is 36.7.The transplanted kidney located in right iliac fossa of 89 cases and in left iliac fossa of 2 cases. 91 cases all take the two examinations from 3 days to 7 years (the average time is 40 months).The total frequency of biopsy is 203 with per capita 1.5. The device of CDFI adopts ACUSON Sequoia 512 ultrasound meter. The frequency of detecting head is 3.5Hz.First do multi-cross-section investigation of transplanted kidney at right or left iliac fossa by 2D(2-DIMENSIONAL) ultrasound, observing the morphous, size, circumstance and internal structure of the transplanted kidney. Then observe the renal blood flow by CDFI, recording Systolic Proximal Velocity(SPV), End Diastole Velocity(EDV), Resistence Index(RI), Pulsatility Index(PI), the ratio of Systolic blood flow rate and End-diastole blood flow rate (S/D). Statistical treatment is carried out about these parameters. Renal needle biopsy are taken on these 91 cases and compare with the diagnoses of color Doppler ultrasound. The device of biopsy adopted auto biopsy device and cutting needle select 18G Tru-cut1 biopsy needle. Biopsy was taken on upper pole of kidney in 15 cases and inferior pole of kidney in 76 cases. The result of these 91 cases by CDFI is: the stable group contains 38 cases which have no abnormality seen. The transplanted kidney is normal in size and its bloodstream is abundant and clear. Among the total, the urinary volume of 34 cases is 1000-2000ml/L on average. The temperature of them is normal. serum creatinine<130μmol/L and urea nitrogen is normal. Combining with clinic, the 34 cases are in stable phase. In renal needle biopsy, there are no rejection manifestations in these 34 cases, such as glomcrulus increasing, glomerular angiotelectasi,endotheliocyte swelling,renal interstitiu -m edema,no lymphomonocyte infiltrating,interstitial angiotelectasis,nephric tubule destruction,endomembrane thickening and so on.Another 4 patho-conse -quence report:3 cases that have severe epithelialis cellula proliferation, persistent endotheliocyte proliferation, mesenterium light hyperplasy and typical hump changes are glomerular nephritis. 1 case which has glomerular capillary gently distension and congestion, basal membrane a little thickening, renal interstitium lymphomonocyte infiltrating that mainly distribute around blood vessel and glomerulum, no interstitial manifest edema and PAS dyeing nephric tubule inflammation is interstitial nephritis.32 cases are diagnosed acute rejection by CDFI.The volume of transplant -ed kidney is obviously increasing.The echo of renal parenchyma is enhancing. Corpus Malpighii is swelling,of which the echo is decreasing, and turning round from triangle. The altitude of Corpus Malpighii is exceed corresponding cort.The width of renal sinus shrink correspondingly. The rate of the width of renal sinus and renal parenchyma is below 1/2. The clinical manifestation is hypourocrinia, weight gain, blood pressure heighten, Blood urea nitrogen and creatinine heighten. The puncturing patho-examination of 28 cases appear suffusing interstitial edema, inflammatory cell infiltrate, extensive deposit of hemaleucin and platelet in renal arteriole and glomerular capillary,which result in narrowing of Lumen of blood vessel.Part of the blood vessels are completely blunting with midrange intercapillary Cellular proliferation and mesenterium base widening. Another 4 cases are diagnosed acute tubular necrosis(ATN) by pathology.Chronic rejection happened in 18 cases by CDFI. The following patholog -ic changes can be seen in 16 cases by renal needle biopsy: part of the glomcrulus has completely fibrosis,the others have basal lamina thickening; part of the glomerular capsule wall fibrosis with mesenterium dissolving and basal lamina presenting double-track by PAS dyeing; glomcrulus analosis obviously and renal tubular epithelial cells become vacuolus with cast,interstit -ial fibrosis Lamellar distributing. There are low grade inflammatary cells infiltrating,but plasma cells are not apparent. Renal arteriole and micr-artery are thickening obviously with narrow lumina and transparent-changed vessel wall. Part of arteriole are thickening and blenno-change seemingly, which change obviously like onion. The other 2 cases are intoxing with ciclosporin A by pathologic diagnose.2 cases are diagnosed acute tubular necrosis by CDFI among the 91 cases. RI of transplanted kidney increase 2 days after operation. RI:0.71±0.15. The volume of the transplanted kidney enlarged a little,but the long diameter didn,t exceed 10.8±0.9cm and the thickness didn,t exceed 4.9±0.8 cm. The cone enlarged with the echo decreasing or diminishing. Anti-rejection treatment have no effect on the cases that oliguresis;oliguria happende immidiately after the operation,but have no other clinical manifestations. RI recovered 10-15 days after the treatment.But 6 cases in 91 are ATN. Completely fibrosis on glomcrulus and capsula glomeruli, sever and extensive necrosis of nephric tubule with obvious congestion and hemorrhage of interstitial substance can be seen by the pathology. The regeneration of apart renal tubular epithelial cell in which untypical bodies can be seen occasionally.The endomembrane of renal arteriole is thickening with narrow lumina and foam-cell likely cells. In abnormal group, these pathologic phenomenons are found in 4 cases. Such as glomerular angiotelectasis,occasional leukocyte(<3), rarefaction and edema of interstitial substance, focal mononuclearcell infiltrating in cortical area, angiectasis and congestion in the juncture of cortex and medullary substance and generally vacuolar degeneration and necrosis of nephric tubule.Only one case that was intoxing with ciclosporin A was detected by CDFI. 2D ultrasound represented that the transplanted kidney was a little increasing. The general longitude is 11.8±0.7cm and the thickness of cortex is 0.89±0.09cm. RI increase no more than 0.73±0.23 by CDFI. Cmax monitoring was taken at the same time. The Cmaxes of 2 cases were both over 400 ng/ml. RI was descending after adjusting treatment, which was falling to nomal level after 3,5 days. The results of Cmax monitoring was seperately 150 ng/ml and 223 ng/ml. 3 cases that were intoxing with ciclosporin A were detected by renal needle biopsy. The following pathologic phenomenons were reported. Part of the glomcrulus were completely ischemic necrosis, but the others had apparent thickening blood capillary basal membrane. The glomerular arteriole hyalinized with thick endarterium and lymphocyte infiltrating in focus-form interstitial substance. Canoula inflammation could also be seen with nephric tubule shrinking and trabs–form fibrosis in interstitial substance. Another 2 cases in abnormal group were mild poisoning with ciclosporinA by transplanted renal needle biopsy. The pathology reported that glomcrulus capillary was a little expanding and the basal membrane a little thickened with double-track phenomenon by PAS dyeing. Mononuclearc -ell infiltrated renal interstitium occasionally and they were mainly monocyte and lymphocyte. The blood vessel of interstitial substance is lightly expanding and congestive. The afferent arteriole of glomerulus hyalinized too. Obvious vacuolar degeneration and necrosis of endothelial cell could be detected in the nephric tubule, especially the proximal convoluted tubule.Banff classification: among these 91 cases , 34 of the 38 normal cases diagnosed by CDFI is in stable phase confirmed by biopsy. 3 cases were glomerular nephritis and 1 case is interstitial nephritis diagnosed by pathology. Acute rejection happened on 32 patients diagnosed by CDFI and 28 patients diagnosed by ultrasound guided puncture. Pathologic diagnosis of another 4 cases is acute tubular necrosis. Chronic rejection happened on 18 cases diagnosed by CDFI and 16 cases diagnosed by biopsy. The pathologic diagnosis of another 2 cases is ciclosporinA poisoning. ANT is 2 cases found out by CDFI and 6 cases verified by pathology. CiclosporinA poisoning is 1 case by CDFI and 3 cases by pathology.The corerect rate of clinical diagnosis: comparing with the pathologic result, the rate is 77.0% by CDFI and it is 100% by renal needle biopsy.The pathologic outcome of transplanted renal needle biopsy is the most accurate and prompt gold standard according to the analysis of data in this text.
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