Analysis of expression of TNF-alpha and TGF-beta3 in intrinsic ureteropelvic junction obstruction

OBJECTIVES

Ureteropelvic junction (UPJ) obstruction is of critical importance to understand the histopathology of UPJ obstruction in terms of therapy planning and follow-up. For this purpose, our study was conducted with TNF-α and TGF-β markers to investigate possible underlying problems in intrinsic UPJ obstruction.

METHODS

Of the patients who had undergone surgery in our clinic, 36 UPJ segments of patients who had undergone dismembered pyeloplasty surgery due to UPJ obstruction and 14 UPJ segments of the patients who had undergone nephrectomy were collected to form 2 groups. All histological sections were examined by applying immunohistochemical transforming growth factor beta 3 (TGF-β3) and tumour necrosis factor alpha (TNF-α) monoclonal antibody dyes.

RESULTS

The mean staining values for TNF-α in mucosal tissue and mucosa were 0.53±0.84 and 0.58±0.84, respectively in the obstruction group, whereas the values observed in the control group were 0.86±0.36 and 0.93±0.47, respectively. While the mean staining values in the obstruction group in mucosal tissue and mucosa for TGF-β3 were 1.75±0.73 and 2.17±0.77, respectively, the values established in the control group were 1.14±0.66 and 1.43±0.93, respectively. The difference between the obstruction and control groups were statistically significant for both values (p<0.05).

CONCLUSION

Only a limited number of studies have been carried out on this particular issue. Data from the present study indicate that TGF-β3 and TNF-α may play a role in the histopathogenesis of UPJ obstruction (Tab. 1, Fig. 1, Ref. 18).

The impact of C4d staining as a humoral injury marker

PURPOSE

Acute and chronic humoral injuries in renal transplant recipients are the main reasons for graft rejection and failure. Histological and clinical characteristics of humoral rejection and symptoms are variable and not always helpful for differential diagnosis. Clinical monitoring of the allograft, an elevated serum panel-reactive antibody (PRA), and the presence of donor-specific antibody (DSA) during immune monitoring as well as C4d staining of biopsy material can establish the differential diagnosis. Even without a cellular component, humoral rejection reaction is serious because the target tissue is the graft endothelium. Because the kidney graft has a rich vascular structure this attack causes permanent injury to the kidney in the long term. Graft dysfunction in this setting is usually more severe, requiring dialysis therapy, compared with acute cellular reactions. Positive C4d staining of peritubular capillaries in biopsy material represent a hallmark of complement-dependent cytotoxicity, supporting the diagnosis of humoral rejection. We analyzed C4d staining as a hallmark of humoral rejection.

METHODS

From 2009 to 2011, we analyzed the relationship between pathological findings of C4d immunohistochemistry staining and the clinical outcomes of 45 kidney transplant recipients who underwent a kidney biopsy because of graft dysfunction due to possible humoral rejection.

RESULTS

Biopsy specimens of 15 patients stained C4d positive; the remaining 30 showed negative results. Intravenous steroids, PP + IVIG with or without antithymocyte globulin (ATG), was administered for treatment. Sixty six percent (n = 10) of patients were C4d positive with 16% (n = 5) of those showing C4d-negative biopsy results, losing their grafts, and returning to hemodialysis.

CONCLUSIONS

C4d staining refractory humoral rejection injury was related to poor graft outcomes.

Salvage repair of anastomotic dehiscence following colon surgery using an expanded polytetrafluoroethylene graft

Anastomotic dehiscence is a serious complication of colorectal surgery that causes death in up to 40% of cases in which it occurs. Edema and inflammation due to abdominal sepsis can prevent the use of standard management (i.e., colostomy, ileostomy or Hartmann's procedure), in which case alternative salvage repair methods are required. The present report describes the treatment of a 73-year-old female patient at high risk of mortality because of intraabdominal sepsis due to suture dehiscence following a right hemicolectomy and ileo-transversostomy. Several surgical repair procedures were tried, but all failed. We then used an expanded polytetrafluoroethylene (ePTFE) graft in salvage repair, and this approach proved successful. This is the first report to describe clinical, macroscopic and histopathological findings, following use of an ePTFE graft in colorectal repair in humans.