Author: Leo
Keywords: transplantation kidney | renal interstitial fibrosis | renal
transplantation | perfusion therapy | mycophenolic acid
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| From google images |
Chronic renal allograft nephropathy (CAN) is the most important cause of long-term renal failure, often months after transplantation to several years, the main pathological changes include glomerular sclerosis, renal interstitial fibrosis and tubular atrophy The Other Xu et al. Found that reducing osteopontin (OPN) in vivo can significantly inhibit epithelial cell transdifferentiation of mesenchymal cells, reduce renal interstitial fibrosis, and delay the progress of CAN.
Chronic renal allograft nephropathy (CAN) is the most important cause of long-term renal failure, often months after transplantation to several years, the main pathological changes include glomerular sclerosis, renal interstitial fibrosis and tubular atrophy The Among them, renal tubular atrophy and renal interstitial fibrosis is a key factor in determining the long-term prognosis of the transplanted kidney.
At present, the diagnosis of CAN to renal biopsy-based, still lack of sensitivity and specificity of high and noninvasive diagnostic methods; treatment mainly immunosuppressive therapy, widely used cyclosporine drugs with strong renal toxicity And other adverse reactions, the clinical still lack of high specificity, less adverse reactions to the treatment program. In this paper, we will summarize the current research progress in the diagnosis and treatment of renal interstitial fibrosis, and provide a reference for further improving the survival rate of long-term transplanted kidney.
Diagnosis
At present, the "gold standard" for the diagnosis of renal interstitial fibrosis is transplanted with renal biopsy [3]. This method is not only invasive, but also can not be repeated at any time, which will bring inconvenience to patients with long-term follow-up. Therefore, it is imperative to find early, effective and noninvasive methods for the diagnosis and monitoring of the development of renal interstitial fibrosis.
Molecular biology diagnosis
MicroRNA (miRNA) miRNA is a class of about 22 nucleotides of endogenous, non-coding RNA, can be combined with messenger RNA (mRNA), leading to gene silencing after transcription, and then in a variety of pathophysiology and disease The process plays a key role.
Recent miRNA-142-3p, miRNA-204 and miRNA-211 have been shown to be differentially expressed in urine samples of patients diagnosed with renal interstitial fibrosis, and many miRNAs have been involved in the process of renal fibrosis. Abnormal expression of miRNA-21 in mouse renal fibroblasts promotes the differentiation of myofibroblasts and increases significantly in circulating blood of patients with renal interstitial fibrosis. Maulf et al. Found a group of miRNA-125b, MiRNA-203, miRNA-142-3p, miRNA-204 and miRNA-211 can be used to monitor renal allograft function and suggest that this group of miRNAs may be involved in the development of renal interstitial fibrosis.
Therefore, the above results indicate that miRNAs are likely to play an important role in the development and progression of renal interstitial fibrosis and can be used as a noninvasive biomarker for dynamic monitoring of renal interstitial fibrosis in renal transplant recipients.
Compared with renal biopsy, combined with quantitative detection of renal transplant recipients in the circulation of blood and urine miRNAs with simple, noninvasive, time-saving and other advantages, but its sensitivity and specificity and reflect the progress of the disease, treatment, prognosis value To be large-scale, long-term clinical studies confirmed.
Messenger RNA (mRNA) It is well known that proteins encoded by mRNA are involved in the development of many diseases. Recent studies have shown that monitoring changes in expression can be used to diagnose renal interstitial fibrosis.
Anglicheau et al. Found that the sensitivity and specificity of the combined detection of four mRNAs including vimentin, Na-K-2C1 co-transporter (NKCC2), E4 geminin and 18S ribosomal KNA were used to diagnose renal interstitial fibrosis 93.8% and 84.1%, respectively, and the sensitivity and specificity of the study were 77.3% and 87.5%, respectively, in another independent clinical trial. Therefore, the above-mentioned detection method can be used as a molecular biology means for diagnosing the interstitial fibrosis of transplanted kidney. However, at present, this method can not classify the degree of interstitial fibrosis in renal transplant recipients, so further research is needed.
(CTGF) levels in renal transplant recipients were independently associated with the degree of renal interstitial fibrosis in renal biopsy, with elevated CTGFu levels in March after renal transplantation Renal transplantation in 24 months after transplantation in renal and severe renal interstitial fibrosis, so quantitative detection of CTGFu can reflect the degree of renal interstitial fibrosis.
Physics diagnosis
As a new noninvasive elastic imaging technique, Acoustic Pulse Radiation (ARFI) elasticity imaging has been applied to the detection of liver fibrosis by short-term, high-energy ultrasonic focused thrust pulse detection of organ hardness.
ARFI quantitative analysis of the degree of renal fibrosis and BANFF score is closely related to another study does not support ARFI elastic imaging technology for a lower degree of transplantation of renal interstitial fibrosis, and in the same patient multiple tests and The results of detection between patients varied greatly. Therefore, AFRI elastography can be used as a physical method for assessing grafting renal fibrosis in the future, but still need to be improved in improving sensitivity and specificity.
Transient elastic scanning (TE) with instrument scanning to complete, in recent years to determine the degree of liver fibrosis imaging technology, with fast, painless, repeatable, noninvasive and so on. Sommerer et al. Applied it to the diagnosis of renal interstitial fibrosis, and TE achieved reliable results in 72% of the detected cases, especially in cases where advanced renal interstitial fibrosis was diagnosed. But this method by the height, body mass index, transplant kidney and skin spacing and other factors interfere with the future need to rule out the potential interference factors.
As the molecular biology and physical diagnosis methods reflect the different focus of transplanted renal interstitial fibrosis, therefore, in the future clinical application can try to use in combination to improve the detection sensitivity and specificity.
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