肾移植受者蛋白尿病因分析及临床处理  

Analysis on causes of proteinuria after kidney transplantation and the corresponding clinical measurements

作　　者：潘光辉[1] 方佳丽[1] 李德胜[1] 陈正[1] 李光辉[1] 张磊[1] 徐璐[1] 毕文浩[1] 艾威[1] 马俊杰[1] 廖德怀[1] 

机构地区：[1]广州医学院第二附属医院器官移植科,510260

出　　处：《中华移植杂志（电子版）》2010年第3期24-27,共4页Chinese Journal of Transplantation(Electronic Edition)

摘　　要：目的探讨肾移植受者蛋白尿的病因和临床对策。方法对广州医学院第二附属医院2006年7月至2010年8月随访中出现蛋白尿的103例肾移植受者进行移植肾穿刺活组织检查(简称活检),根据病理学诊断进行相应的临床治疗。结果 103例移植肾活检中急性排斥反应32例,慢性排斥反应25例,肾小球肾炎30例(其中IgA肾病12例),肾小管-间质损伤7例,其他9例(包括肾小球轻微病变6例,糖尿病肾损害3例)。经过分类治疗后70.9%(73/103)受者蛋白尿逆转,肾功能维持稳定。结论排斥反应和原有肾疾病复发是导致肾移植受者蛋白尿的主要原因,移植肾活检是早期明确蛋白尿病因的有效手段,根据病理学诊断结果进行分类治疗可取得良好临床效果。Objective To explore the causes of proteinuria after kidney transplantation and the corresponding clinical measurements. Methods A total of 103 patients, who were diagnosed with proteinuria in the Second Affiliated Hospital of Guangzhou Medical University during July 2006 and August 2010, were taken renal allograft biopsy and were treated according to the biopsy results. Results The diagnosis from biopsy were as following： 32 acute rejection, 25 chronic rejection, 30 nephritis （including 12 IgA nephropathy）, 7 tubular-interstitial injury, 6 minor glomerular lesions, and 3 renal damages because of diabetes. After treatment, proteinuria in 70.9% （73/103） of these patients was reversed, with a stable renal function. Conclusion Rejection and recurrence of primary renal disease may be the main causes of proteinurla after kidney transplantation. Renal biopsy is an effective method for identification of the causes of proteinuria. Proper clinical measurements should be carried out based on biopsy results.

关 键 词：肾移植 蛋白尿 活组织检查 病因 治疗 

分 类 号：R699[医药卫生—泌尿科学]