移植肾复发性局灶、节段性肾小球硬化二例  

Recurrence of local segmental glomerulosclerosis in 2 patients with renal allograft and review

作　　者：马俊杰[1] 于立新[1] 徐健[1] 王国保 王冠苏[3] 

机构地区：[1]第一军医大学附属南方医院肾移植科,广州510515 [2]第一军医大学附属南方医院肾脏病科,广州510515 [3]郑州市第七人民医院泌尿外科

出　　处：《中华器官移植杂志》2003年第1期33-35,共3页Chinese Journal of Organ Transplantation

摘　　要：目的　报道移植肾复发性局灶、节段性肾小球硬化 (FSGS)二例。方法　肾病综合征、肾功能衰竭患者 2例 (1 5岁 ,2 5岁 ) ,病理诊断均为FSGS ,分别于肾移植术后 2周和 1年半复发肾病综合征。移植肾病理特征 :肾小球节段性硬化 ,以IgM为主的免疫球蛋白局灶性块状沉积于系膜区 ,弥漫性上皮细胞变性及足突融合 ,诊断FSGS复发。采用血浆置换和血管紧张素转换酶抑制剂(ACEI)治疗。结果　经血浆置换和ACEI治疗后 ,尿蛋白明显减少 ,随访 1 2个月以上 ,无进一步恶化 ,血肌酐稳定。Objective Recurrence of local segmental glomerulosclerosis (FSGS) in 2 patients with renal allograft was reported.Methods A male child aged 15 years and a male adult aged 25 years with primary FSGS, who were subjected to cadaveric kidney transplantation, had a recurrent nephritic syndrome showing massive proteinuria, hyperlipidemia and hypertension respectively in 2 weeks and 18 months postoperatively, that was suspected a recurrent FSGS. The child immediately was treated with Benazepril hydrochloride, 30?mg /day plus high dosage of Prednisolone ( 1?mg /kg every day) for 6 weeks, but proteinuria did not to be ameliorated. The adult was treated with high dosage of Prednisolone ( 1?mg /kg every) and Tripterygium wifordii for 12 weeks, but the syndrome was not improved. Results Two patients had recurrent FSGS according to renal biopsy revealing characterized by similar features: diffuse effacement of foot processes on electron microscope, segmental or focal sclerosis under light microscope and IgM, IgG, C3 deposits. The therapy of plasmapheresis as well as high dosage of Benazepril hydrochloride was added to institute respectively for continuous 3 sessions with removal of 1.5 volume plasma ( 1 200?ml of plasma) in the child and successive 6 sessions with removal of same volume ( 3 000?ml of plasma). The child's proteinuria had a significant reduction from 8.29?g /day to 4.52?g /day after a week post pheresis, that kept 4.52 ～ 5.56 ?g/day with stable creatitine (180～200?μmol/L) following 18 months. The adult's proteinaria obvious decreased from 4.68?g /day to 1.50?g /day after plasma exchange a week and keeping decline to 1.06?g /day with normal renal function following 12 months. Conclusion FSGS may immediately be recurrence in pediatric renal transplants. The mechanism of recurrent FSGS may be associated with excessive glomerular filtration, circulating factor altering glomerular permeability, injection of anti thymocyte and lymphocyte immunoglobul

关 键 词：肾移植 肾小球硬化症 复发 移植物 病例报告 FSGS 

分 类 号：R699.2[医药卫生—泌尿科学] R692.6[医药卫生—外科学]