Summary: The aim of the study was to determine the incidence of renal venous system congenital anomalies in the Polish population. Material and method: Vascular kidney samples were investigated by means of preparations and X-ray contrasting. The study the group comprised 281 male and 269 female specimens. Results: Congenital anomalies were diagnosed in 186 patients (33 8% of all cases), and they were more frequent in men than in women, albeit that difference was non-significant. The following anomalies were most commonly observed: multiple venous variations on the right side (20.4%), retroaortic course of the left renal vein (4.2%), and circumaortic venous ring of the left renal vein (3.8%). Other anomalies were diagnosed in 1%-2% of cases. Conclusions: Awareness and preoperative assessment of the venous system before abdominal aortic surgery, isolated collection of renal venous blood samples, and urological or kidney transplantation procedures is essential.
The increasing prevalence of diabetic kidney disease (DKD), a common complication of type 1 and type 2 diabetes, is becoming a leading risk factor of developing end stage renal disease (ESRD). The multiple mechanisms involved in renal tissue damage are a challenge for effective targeted therapy. Urolithins are metabolites generated by gut microbiota upon dietary intake of plant-derived elagitannins. Multidirectional effects of these compounds include their anti-inflammatory, antioxidant, anti-proliferatory, anti-migratory and antiglycative properties that are mediated by modulation of signaling pathways and gene expression. Biochemical properties of urolithins indicate their capacity to regulate numerous mechanisms responsible for developing the hyperglycemia-induced tissue injury. The potentially beneficial effects of urolithins on podocytes, the most vulnerable renal cells should be particularly considered. The purpose of this review is to provide the evidence from the in vivo and in vitro studies showing that urolithin-based therapy could be a useful tool for protecting the kidneys from damage in diabetes.
Autosomal dominant polycystic kidney disease is the most common genetic cause of renal failure. Apart from kidney involvement, patients are at risk of extra-renal manifestations, including vascular lesions. The etiology of vascular changes is diverse and depends, among other factors, on polycystin gene mutation, increased activity of the renin-angiotensin-aldosterone system and the occurrence of hypertension. The observed vascular system complications include cerebral artery aneurysms, cervico-encephalic arteries' dissection, aortic aneurysm and dissection and intracranial arterial dolichoectasia. This article discusses the etiopathogenesis, symptomatology, principles of prevention and treatment of the aforementioned diseases of the vascular system accompanying polycystic kidney disease.
Live donation remains the single most consistent factor affecting long-term results of the transplantation. Open live donor nephrectomy is associated with high traumatization and possibility of complications due to large skin incision. The alternative is laparoscopic live donor nephrectomy (LDN) which is widely used in many countries. We present the case of LDN. The retroperitoneal approach was applied and time of operation was 210 min. The immediate function of transplanted kidney was observed. Authors hope that the offering this minimally invasive procedure to the potential donors may popularize the idea of live donation in Poland.
The presence of surfactant proteins was investigated in the human organ of Corti, Eustachian tube and kidney tissues. It has previously been shown that lamellar bodies are present in hairy cells of organ of Corti, in the cytoplasm of secretory and lumen of tubal glands of Eustachian tube and kidney renal basement membrane. No evidence for the presence of surfactant proteins in the organ of Corti and kidney has been presented until now. The aim of this study was to find out if surfactant proteins were expressed in other epithelia such as organ of Corti, Eustachian tube and kidney. Surfactant proteins were identified using one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis and Western blotting. On one-dimensional Western blots, bands for surfactant protein A in human Eustachian tube (SP-A, 34 kDa) and in kidney extracts, and for surfactant protein D (SP-D, 43 kDa) in Eustachian tube and in kidney extracts (SP-D, 86 kDa), and for surfactant protein B (SP-B, 8 kDa) in human Eustachian tubeand organ of Corti extracts were detected. Bands corresponded to monomeric forms of lung surfactant proteins. These results indicate the presence of SP-A and SP-D in kidney epithelium, SP-A, SP-B and SP-D in Eustachian tube and SP-B in the organ of Corti.
2-oxoglutarate dehydrogenase (2-OGDH) is the key regulatory enzyme of cell metabolism. It has been previously demonstrated that in rats subjected to protein restriction low, clinically relevant doses of fibrates up-regulate liver 2-OGDH and promote 2-oxoglutarate catabolism. The aim of the present study was to evaluate the effect of low doses of fenofibrate and bezafibrate on renal 2-OGDH complex in rats fed low-protein chow. Fibrates were administrated for 14 days to Wistar male rats at one daily doses of 5, 10 and 20 mg/kg b.wt./day. The 2-OGDH activity was assayed spectrophotometrically. The mRNA levels for 2-OGDH catalytic subunits (E1 and E2) and PPARα were quantified by means of semi-quantitative reverse-transcription-PCR. 2-OGDH activity increased in response to administration of fenofibrate and bezafibrate (by 11, 24, 32% and 9, 12, 21%, respectively). The difference was statistically significant for the doses of 10 and 20 mg/kg b.wt of fenofibrate (p<0.001) and the highest dose of bezafibrate (p<0.05). Stimulation of 2-OGDH was not accompanied by changes in mRNA levels for E1 and E2. In addition, mRNA level for PPARα did not change. It is conceivable that fibrate-induced stimulation of 2-OGDH activity can affect renal metabolism and contribute to changes in kidney functions.
Renal artery pseudoaneurysms and arteriovenous fistulae most often occur as an iatrogenic complication. The article discusses a case of a patient diagnosed with an arteriovenous fistula and a pseudoaneurysm. A 64-year-old woman was admitted to the hospital due to nonspecific pain in the lumbar region. Imaging showed a typical picture of clear cell renal carcinoma. The patient was qualified for surgical treatment. After tumor resection, the patient developed microhematuria. Arteriovenous fistula and renal pseudoaneurysm were diagnosed using Doppler and computed tomography scans. The patient was qualified for arteriography with simultaneous embolization of the lesion. A follow-up evaluation confirmed the exclusion of aneurysm and fistula. Treatment outcomes were monitored using Doppler ultrasound. Doppler ultrasonography is the first method of choice in detecting and monitoring renal artery irregularities. Safety, non-invasiveness and easy access to this tool make it play a key role in the diagnosis of renal artery fistulas and pseudoaneurysms.
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Pseudotętniaki tętnic nerkowych i przetoki tętniczo-żylne nerek pojawiają się najczęściej jako powikłania jatrogenne. W pracy omówiono przypadek chorej, u której w badaniu ultrasonograficznym i tomografii komputerowej rozpoznano przetokę tętniczo-żylną i tętniaka rzekomego, zlokalizowane w nerce prawej, a następnie leczonej metodami wewnątrznaczyniowymi. Sześćdziesięcioczteroletnia kobieta została przyjęta do szpitala z powodu niespecyficznych dolegliwości bólowych w okolicy lędźwiowej. Badania obrazowe wykazały typowy obraz dla jasnokomórkowego raka nerki. Chorą zakwalifikowano do leczenia chirurgicznego. Po resekcji klinowej u pacjentki obserwowano okresowy krwinkomocz. Za pomocą badania dopplerowskiego i tomografii komputerowej zdiagnozowano przetokę tętniczo-żylną i tętniaka rzekomego nerki prawej. Chorą zakwalifikowano do arteriografii z równoczasową embolizacją. Po zabiegu embolizacji badania kontrolne potwierdziły wyłączenie tętniaka i przetoki z krążenia. Wyniki leczenia monitorowano za pomocą badań dopplerowskich. Ultrasonografia dopplerowska jest metodą z wyboru w wykrywaniu i monitorowaniu nieprawidłowości tętnic nerkowych. Bezpieczeństwo, nieinwazyjność i dostępność badania sprawiają, że odgrywa ono kluczową rolę w diagnozowaniu przetok tętnic nerkowych i pseudotętniaków.
This study aimed to assess levels of silver nanoparticle residues in eggshells and tissues as well as the levels of selected biochemical parameters and oxidative stress indices in chickens hatched from nanosilver disinfected eggs. The samples included 40 Greenleg Partridge chicks allocated into two groups. The experimental group (group D) consisted of chickens hatched from eggs disinfected with a nanosilver preparation prior to incubation, while the control group (group C) included chickens whose eggs were exposed to UV radiation for disinfection. The eggshells and kidney sections obtained from group D chickens showed a significantly higher silver level compared to group C. For the biochemical parameters, only the uric acid content was higher in group D compared to group C. Analysis of the antioxidative stress biomarkers (superoxide dismutase and catalase), showed a significant increase in group D in relation to group C.
Background. There is evidence that dyslipidemia is associated with chronic kidney disease (CKD) and it has been implicated in the progression of renal damage. Optimal management of dyslipidemia should therefore lead to renal benefits. A number of experimental models demonstrate a beneficial effect of statins in ameliorating renal damage. However, the exact mechanism by which statins protect against renal damage remains unclear. Methods. In a placebo-controlled, randomized, cross-over study we evaluated the influence of atorvastatin (ATO) 40 mg/day added to the renin-angiotensin-aldosterone systeme (RAAS) blockade on proteinuria and surrogate biomarkers of tubular damage or injury in 14 non-diabetic patients with proteinuria (0.4-1.8 g per 24 h) with normal or declined kidney function (eGFR 55-153 ml/min). In the eight-week run-in period, therapy using angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II subtype 1 receptor antagonists (ARB) was adjusted to achieve a blood pressure below 130/80 mm Hg. Next, patients were randomly assigned to one of two treatment sequences: ATO/washout/placebo or placebo/washout/ATO. Clinical evaluation and laboratory tests were performed at the randomization point and after each period of the study. The primary end point of this study was a change in proteinuria measured as 24-h urine protein excretion (DPE). Secondary end points included urine N-acetyl-β-d-glucosaminidase (NAG) and α1-microglobulin (α1m) excretion. Results. The ATO therapy significantly reduced urine excretion of α1m (p=0.033) and NAG (p=0.038) as compared to placebo. There were no differences in proteinuria, blood pressure, eGFR and serum creatinine between the ATO and placebo groups. Conclusion. Atorvastatin treatment is safe and improves biomarkers of tubular damage or injury in non-diabetic patients with CKD.
We investigated the effect of the cyclic AMP-protein kinase A (PKA) signalling pathway on renal Na+,K+-ATPase and ouabain-sensitive H+,K+-ATPase. Male Wistar rats were anaesthetized and catheter was inserted through the femoral artery into the abdominal aorta proximally to the renal arteries for infusion of the investigated substances. Na+,K+-ATPase activity was measured in the presence of Sch 28080 to block ouabain-sensitive H+,K+-ATPase and improve specificity of the assay. Dibutyryl-cyclic AMP (db-cAMP) administered at a dose of 10-17 mol/kg per min and 10-6 mol/kg per min increased Na+,K+-ATPase activity in the renal cortex by 34% and 42%, respectively, and decreased it in the renal medulla by 30% and 44%, respectively. db-cAMP infused at 10-6 mol/kg per min increased the activity of cortical ouabain-sensitive H+,K+-ATPase by 33%, and medullary ouabain-sensitive H+,K+-ATPase by 30%. All the effects of db-cAMP were abolished by a specific inhibitor of protein kinase A, KT 5720. The stimulatory effect on ouabain-sensitive H+,K+-ATPase and on cortical Na+,K+-ATPase was also abolished by brefeldin A which inhibits the insertion of proteins into the plasma membranes, whereas the inhibitory effect on medullary Na+,K+-ATPase was partially attenuated by 17-octadecynoic acid, an inhibitor of cytochrome P450-dependent arachidonate metabolism. We conclude that the cAMP-PKA pathway stimulates Na+,K+-ATPase in the renal cortex as well as ouabain-sensitive H+,K+-ATPase in the cortex and medulla by a mechanism requiring insertion of proteins into the plasma membrane. In contrast, medullary Na+,K+-ATPase is inhibited by cAMP through a mechanism involving cytochrome P450-dependent arachidonate metabolites.
The aim of this work was to develop a method for renal H+,K+-ATPase measurement based on the previously used Na+,K+-ATPase assay (Bełtowski et al.: J Physiol Pharmacol.; 1998, 49: 625-37). ATPase activity was assessed by measuring the amount of inorganic phosphate liberated from ATP by isolated microsomal fraction. Both ouabain-sensitive and ouabain-resistant K+-stimulated and Na+-independent ATPase activity was detected in the renal cortex and medulla. These activities were blocked by 0.2 mM imidazolpyridine derivative, Sch 28080. The method for ouabain- sensitive H+,K+-ATPase assay is characterized by good reproducibility, linearity and recovery. In contrast, the assay for ouabain-resistant H+,K+-ATPase was unsatisfactory, probably due to low activity of this enzyme. Ouabain-sensitive H+,K+-ATPase was stimulated by K+ with Km of 0.26 ± 0.04 mM and 0.69 ± 0.11 mM in cortex and medulla, respectively, and was inhibited by ouabain (Ki of 2.9 ± 0.3 μM in the renal cortex and 1.9 ± 0.4 μM in the renal medulla) and by Sch 28080 (Ki of 1.8 ± 0.5 μM and 2.5 ± 0.9 μM in cortex and medulla, respectively). We found that ouabain-sensitive H+,K+-ATPase accounted for about 12% of total ouabain-sensitive activity in the Na+,K+-ATPase assay. Therefore, we suggest to use Sch 28080 during Na+,K+-ATPase measurement to block H+,K+-ATPase and improve the assay specificity. Leptin administered intraperitoneally (1 mg/kg) decreased renal medullary Na+,K+-ATPase activity by 32.1% at 1 h after injection but had no effect on H+,K+-ATPase activity suggesting that the two renal ouabain-sensitive ATPases are separately regulated.
Relatively successful elsewhere, gene delivery aimed at the vasculature and kidney has made very little progress. In the kidney, the hurdles are related to the unique structure–function relationships of this organ and in the blood vessels to a variety of, mostly endothelial, factors making the delivery of transgenes very difficult. Among gene-therapeutic approaches, most viral gene delivery systems utilized to date have shown significant practical and safety-related limitations due to the level and duration of recombinant transgene expression as well as their induction of a significant host immune response to vector proteins. Recombinant adeno-associated virus (rAAV) vectors appear to offer a vehicle for safe, long-term transgene expression. rAAV-based vectors are characterized by a relative non-immunogenicity and the absence of viral coding sequences. Furthermore, they allow for establishment of long-term latency without deleterious effects on the host cell. This brief review addresses problems related to transgene-delivery to kidney and vasculature with particular attention given to rAAV vectors. The potential for gene therapy as a strategy for selected renal and vascular diseases is also discussed.
Aim: The Grainyhead-like 1 (GRHL1) transcription factor is tissue-specific and is very highly expressed in the kidney. In humans the GRHL1 gene is located at the chromosomal position 2p25. A locus conferring increased susceptibility to essential hypertension has been mapped to 2p25 in two independent studies, but the causative gene has never been identified. Furthermore, a statistically significant association has been found between a polymorphism in the GRHL1 gene and heart rate regulation. The aim of our study was to investigate the physiological consequences of Grhl1 loss in a mouse model and ascertain whether Grhl1 may be involved in the regulation of blood pressure and heart rate. Experimental approach: In our research we employed the Grhl1 "knock-out" mouse strain. We analyzed renal gene expression, blood pressure and heart rate in the Grhl1-null mice in comparison with their "wild-type" littermate controls. Most important results: The expression of many genes is altered in the Grhl1-/- kidneys. Some of these genes have previously been linked to blood pressure regulation. Despite this, the Grhl1-null mice have normal blood pressure and interestingly, increased heart rate. Conclusions: Our work did not discover any new evidence to suggest any involvement of Grhl1 in blood pressure regulation. However, we determined that the loss of Grhl1 influences the regulation of heart rate in a mouse model.
Background: Inhibition of the renin-angiotensin-aldosterone system (RAAS) with angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II subtype 1 receptor antagonists (ARB) is a common strategy used in the management of patients with chronic kidney disease (CKD). However, there is no universal therapy that can stop progression of CKD. Pentoxifylline (PTE) is a non-specific phosphodiesterase inhibitor with anti-inflammatory properties. It has been reported to have promising effects in CKD treatment. Methods: In a placebo-controlled, randomized, cross-over study we evaluated the influence of PTE (1200 mg/day) added to RAAS blockade on proteinuria, surrogate markers of tubular injury and oxidative stress-dependent products in 22 non-diabetic patients with proteinuria (0.4-4.3 g per 24h) with normal or declined kidney function [eGFR 37-178 mL/min]. In an eight-week run-in period, therapy using ACEI and/or ARB was adjusted to achieve a blood pressure below 130/80 mm Hg. Next, patients were randomly assigned to one of two treatment sequences: PTE/washout/placebo or placebo/washout/PTE. Clinical evaluation and laboratory tests were performed at the randomization point and after each period of the study. Results: The PTE therapy reduced proteinuria (by 26%) as compared to placebo. There were no differences in α1-microglobulin, urine excretion of N-acetyl-β-d-glucosaminidase (NAG), hsCRP, the urinary excretion of 15-F2t-isoprostane, blood pressure (BP), eGFR and serum creatinine between the PTE and placebo groups. Conclusion: Pentoxifylline may decrease proteinuria in non-diabetic patients with CKD.
The most undesired complication of renal angi- omyolipoma (AML) is bleeding. Because of tumor rupture, the bleeding can spread to the retroperitoneal field and can be severe enough to be life threatening. We report a case of retroperitoneal hemorrhage caused by a ruptured AML that was successfully treated with transarterial embolization with N-butyl cyanoacrylate.
The anatomical structure of urogenital system contributes to high risk of mechanical injuries. The group which is particularly exposed to renal injuries are young men doing sports, the injured of road accidents, victims of accidents in the house or at work. The authors present the medical and surgical treatment after renal injuries. There are blunt and penetrating renal injuries as well as a 5-level classification of kidney injuries according to a degree of injuries – AAST. This classification enables to perform a standardization of different patient groups to choose a proper therapy and to predict the results of treatment. The most of renal injuries involves the medical treatment. However, it is often needed the surgical intervention. The indications for surgical treatment are haemodynamic instability, necessity of surgical verification of concomitant injuries, expanding or throbbing perirenal haematoma confirmed in laparotomy, grade 5 injury. The patients with the serious renal injury should undertake necessary medical examinations to determine a range of injury and to undertake the appropriate treatment. Furthermore, the longterm medical controls are recommended. The contemporary treatment’s approaches, especially AAST scale, are going to medical treatment of blunt renal injuries. The injuries of 1–3 grade are usually treated conservatively and in case of grade 4 and 5, a surgical procedure is needed. Conservative treatment of grade 1–3 injuries does not relate to a risk of late complications. The renal-vascular injuries of 5 grade are treated as an absolute indication for exploratory surgery.
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Budowa anatomiczna układu moczowo-płciowego naraża go na liczne urazy mechaniczne. Grupę szczególnie wysokiego ryzyka stanowią młodzi mężczyźni uprawiający sport, uczestnicy wypadków drogowych, ofiary wypadków w domu lub w miejscu pracy. Autorzy omawiają postępowanie zachowawcze i operacyjne po urazach nerek. Wyróżnia się urazy tępe i penetrujące oraz pięciostopniową klasyfikację urazów nerek według stopnia odniesionych obrażeń – AAST. Klasyfikacja ta pozwala na dokonanie pewnej standaryzacji różnych grup pacjentów i wyboru właściwej terapii oraz stwarza możliwość przewidywania wyników leczenia. Choć w przeważającej liczbie przypadków urazy nerek są leczone zachowawczo, dość często konieczna jest interwencja chirurgiczna. Wskazaniami do leczenia operacyjnego są: hemodynamiczna niestabilność, konieczność weryfikacji operacyjnej urazów towarzyszących, powiększający się lub pulsujący okołonerkowy krwiak stwierdzony podczas laparotomii, V stopień urazu. Pacjenci z poważnym urazem nerki powinni być poddawani niezbędnym badaniom kontrolnym w celu określenia zakresu urazu i wprowadzenia stosownego leczenia. Ponadto zaleca się im podjęcie kontroli długoterminowych. Współczesne algorytmy postępowania, zwłaszcza skala AAST, preferują zachowawcze leczenie tępych urazów nerek. Urazy I–III stopnia leczone są zwykle zachowawczo, w przypadku urazów IV i V stopnia wymagana jest eksploracja chirurgiczna. Leczenie zachowawcze urazów I–III stopnia nie niesie ze sobą ryzyka późnych powikłań. Urazy nerkowo-naczyniowe V stopnia są traktowane jako absolutne wskazanie do leczenia chirurgicznego.
The present work was aimed to obtain information about age-dependent changes of γ-glutamyltransferase (GGT) activity and the levels of non-protein sulfhydryl compounds (NPSH) in rat kidneys. In addition, protein-bound cysteine (PB-Cys), sulfane sulfur compounds and reactive oxygen species (ROS) were estimated The results indicate that the activity of GGT and NPSH levels in the kidneys are reduced with age. At the same time, a significant increase in the level of protein-bound cysteine was observed. Simultaneously, the content of sulfane sulfur compounds was increased in the group of the oldest animals. These findings indicate that the capacity for extracellular glutathione degradation and, in consequence, the availability of cysteine for intracellular glutathione biosynthesis may be impaired. The increased PB-Cys level indicates potentiation of the thiolation reaction, i.e. development of protein-mixed disulfides. These results reveal age dependent disturbances in the thiol-disulfide equilibrium in the kidneys which leads to an imbalance between pro- and antioxidatory processes.
Purpose: To answer the question whether the TSI (tissue strain imaging) sonoelastography technique can contribute to the diagnosis of chronic renal allograft damage. Material and methods: A prospective study of 112 patients between June 2010 and April 2011 was conducted to compare elastography data with biopsy results and laboratory parameters in order to determine whether any correlations exist. Elastography parameters were acquired with a high-end ultrasound system and analyzed using the semiquantitative strain ratio. For comparison, patients were divided into three groups based on biopsy findings (Banff classification): group A: biopsy not necessary; group B: Banff grade I; group C: Banff grades II and III. Correlations were assessed by means of correlation (Pearson) and regression analysis. Differences between ordinal groups were tested for statistical significance by the Mann-Whitney U test. Results: Mean patient age was 54.2 ± 15.01 years. Fifty-nine percent of the patients were male. The calculated TSI strain ratio of groups A and C differed significantly (p = 0.024). Groups B and C (p = 0.056) and groups A and B (p = 0.88) showed no significant difference. The TSI strain ratio did not correlate with glomerular filtration rate (r = 0.105) or creatinine (r = 0.092). Conclusion: The TSI sonoelastography technique can contribute to the differentiation of different stages of renal graft damage (according to Banff classification). However, significant results were not observed for all investigated features. The TSI technique should be further evaluated in future studies including larger numbers of patients.
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Cel: Celem niniejszej pracy było sprawdzenie, czy sonoelastografia TSI (tissue strain imaging – obrazowanie odkształcenia tkanek) może pomóc w rozpoznaniu przewlekłego uszkodzenia nerki przeszczepionej. Materiał i metody: Badanie prospektywne, przeprowadzone od czerwca 2010 do kwietnia 2011 roku, objęło 112 pacjentów. Porównano dane uzyskane w badaniu elastograficznym z wynikami biopsji oraz z parametrami laboratoryjnymi w celu zbadania ewentualnych zależności między nimi. Dane elastograficzne zostały uzyskane przy użyciu wysokiej klasy sprzętu ultrasonograficznego, a ich analizę przeprowadzono, wykorzystując półilościowy wskaźnik odkształcenia (semiquantitative strain ratio). W celach porównawczych pacjenci zostali podzieleni na trzy grupy na podstawie wyniku biopsji (według klasyfikacji Banff): grupa A: biopsja nie jest konieczna, grupa B: stopień I w klasyfikacji Banff oraz grupa C: stopnie II i III według klasyfikacji Banff. Korelacje oceniono za pomocą analizy korelacji (Pearsona) i regresji. Z kolei do oceny istotności statystycznej różnic między badanymi grupami posłużył test U Manna-Whitneya. Wyniki: Średnia wieku pacjentów wynosiła 54,2 ± 15,01 roku. Mężczyźni stanowili 59% badanych. Wykazano istotną różnicę między wskaźnikami odkształcenia TSI dla grup A i C (p = 0,024). Nie wykazano natomiast istotnych różnic między grupami B i C (p = 0,056) oraz A i B (p = 0,88). Nie wykazano również korelacji pomiędzy wskaźnikiem odkształcenia TSI a współczynnikiem przesączania kłębuszkowego (r = 0,105) i kreatyniną (r = 0,092). Wnioski: Sonoelastografia TSI może pomóc w różnicowaniu poszczególnych stadiów uszkodzenia przeszczepu (na podstawie klasyfikacji Banff). Jednak nie dla wszystkich badanych cech otrzymane wyniki były istotne statystycznie. Technika TSI powinna być przedmiotem dalszych badań obejmujących większą liczbę pacjentów.
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