远期移植肾功能不全的临床病理分析

Clinical and histopathological analysis on forward kidney allograft dysfunction

对24例远期移植肾功能不全患者行移植肾穿刺活检,病理诊断慢性排斥反应10例,移植肾膜性肾病5例,慢性排斥合并膜性肾病3例,IgA肾病1例,糖尿病肾小球硬化症1例,环孢素A肾中毒4例。在症状出现后1周内调整免疫抑制药物,13例慢性排斥(含3例肾病)者中11例治疗有效,有效率84.6%,6例移植肾肾病及4例CsA肾中毒者的肾功能恢复正常。认为移植肾肾病是除慢性排斥外导致移植肾功能不全的又一重要原因;慢性排斥的治疗,时间是关键的影响因素;穿刺活检安全、有效,对移植肾功能不全具有较高诊断价值。

Core aspiration biopsy was performed in 24 patients with kidney allograft dysfunction. Histopathological diagnosis demonstrated that chronic rejection was in 10 patients, allograft membranous nephropathy in 5, chronic rejection companied with membranous nephropathy in 3, IgA nephropathy in 1, diabetic glomerulosclerosis in 1 and cyclosporine A nephrotoxocity in 4. The effective rate was accounted for 84.6% (11 cases, including three patients with nephropathy) by adjusting immunosuppressant to treat chronic rejection within one week after symptom occurred. 6 of the patients with nephropathy and 4 with CsA nephrotoxicity returned to normal. Kidney allograft nephropathy was an important factor which caused allograft dysfunction beyond chronic rejection. Time was the critical factor in the treatment of chronic rejection. Core aspiation biopsy, which is safe and effective, has high diagnostic value for kidney allograft dysfunction.