移植肾继发和新发肾小球疾病诊治新进展  

De novo glomerular diseases and recurrence of secondary glomerular disease in renal allograft

作　　者：伍倩倩 倪雪峰 文吉秋 WU Qianqian;NI Xuefeng;WEN Jiqiu(Medical School of Nanjing University,Jiangsu Province,Nanjing 210002,China)

机构地区：[1]南京大学医学院,南京大学医学院附属金陵医院肾脏科 [2]东部战区总医院/国家肾脏疾病临床医学研究中心/全军肾脏病研究所

出　　处：《临床外科杂志》2020年第11期1090-1094,共5页Journal of Clinical Surgery

摘　　要：各类继发性肾小球病变复发和新发肾小球炎的存活率等预后指标受疾病类型及其活动程度的影响。狼疮病人肾移植术后预后较好;淀粉样变性病人移植术后预后与其血液学反应以及是否有严重心脏受累有关;抗肾小球基底膜肾炎肾移植后复发率较低,移植物失功也极为罕见,但抗肾小球基底膜(GBM)阳性病人为移植禁忌证;不同亚型抗中性粒细胞胞浆抗体(ANCA)相关性血管炎的预后不同,但总体预后较好,当病人在移植前达到临床缓解时,移植可安全进行;胰肾联合移植是合并终末期肾病的1型糖尿病病人的首选治疗,且移植后血糖管理至关重要;轻链沉积病肾移植术后的复发率较高,病人存活率较低,但轻链清除的病人仍可以考虑接受肾移植手术,对于其移植后复发的治疗存在争议;De novo膜性肾病(MN)与特发性膜性肾病(IMN)可通过足细胞是否表达HLA-DR以及磷脂酶A2受体染色进行鉴别;De novo局灶节段性肾小球硬化症(FSGS)是新发肾小球肾炎的常见类型,其致病因素多种多样,治疗主要是去除可能致病因素的持续作用。The prognosis of De novo glomerular diseases and secondary glomerular disease depends on the type of Glomerular Diseases and the degree of disease activity.Renal transplantation is associated with good outcomes in patients with ESRD due to lupus nephritis.The prognosis of patients with amyloidosis after transplantation is related to their hematologic response and the presence of severe cardiac involvement.In patients with anti-GBM disease,the recurrence after transplatation is very low and allograft failure from disease recurrence exceedingly rare.However,the patients with serum positive anti-GBM were forbidden for transplantation.The prognosis of different subtypes of ANCA-associated vasculitis nephritis is quite variable,the outcome is favorable and transplantation can be performed safely when the patient has achieved clinical remission before transplantation.Simultaneous pancreas-kidney transplantation is the preferred treatment for type 1 diabetes patients with end-stage renal disease,the management of diabetes is very critical as well.Patient with renal transplantation in light-chain deposition disease has a high disease recurrence but a low survival rate.However,patients with light-chain deposition disease may still be considered for renal transplantation,but the treatment for recurrence is controversial.De novo MN and IMN can be identified by podocyte HLA-DR expression and phospholipase A2 receptor staining.FSGS has been reported as the leading form of de novo glomerular disease,The pathogenic factors are various,and the treatment is mainly to remove the persistent effect of the possible pathogenic factors.

关 键 词：肾移植 继发性肾小球疾病 新发肾小球疾病 危险因素 治疗 预后 

分 类 号：R699.2[医药卫生—泌尿科学]