肾移植术后早期无尿或少尿的诊治(附66例报告)

Diagnosis and Treatment of Early Anuria or Oliguric after Kidney Transplantation(Report of 66 Cases)

目的:探讨肾移植术后早期无尿或少尿的原因及诊治方法。方法:回顾性分析66例肾移植术后早期无尿或少尿患者的发生情况,并分别应用以FK506或CsA为主的免疫抑制剂(FK506/CsA+MMF+Pred)等综合治疗方案。结果:66例肾移植术后早期无尿或少尿的主要原因是急性肾小管坏死(77.27%),其次是急性排斥反应(10.61%),其中有2例移植肾原发无功能和移植肾破裂、肾动脉栓塞各1例术后切除移植肾。FK506组的34例移植肾功能在术后5～35天内均恢复正常;CsA组有1例因急性排斥反应合并严重肺部感染而死亡,24例移植肾功能在术后7～48天内均恢复正常,3例血肌酐在142～215μmol/L之间。结论:肾移植术后早期出现无尿或少尿后应及时分析原因,并给予相应的综合治疗。FK 506+MMF+Pred的三联免疫治疗有助于移植肾功能的早期恢复。

Objective：To investigate the diagnosis and treatment of early anuria or oliguric after kidney trans plantation. Methods.. Retrospective analysis of cause, dignosis and different immunodepressant treatments （FKS06/CsA ＋ MMF ＋Pred） of early anuria or oliguria in the 66 patients after kidney transplantation. Results.. The primary cause of early anuria or oliguric after kidney transplantation in 66 patients was acute tubular necrosis （77.27%, the second was acute rejection （10. 61%）. 2 patients with primary grafts nonfunction, and the other 2 patients with rupture and thrombosis of renal artery respectively, were removed grafts after transplantation. The renal function of 34 patients treated with FK506 became normal in 5-35 d after transplantation. The renal function of 24 patients treated with CsA recovered in 7-48 d after transplantation except 1 patient was dead because of acute rejection combined with serve pulmonary infection. And the other 3 patients＇ serum creatinine ranged from 142 μmol/L to 215 μmol/L. Conclusions：The cause of early anuria or oliguric after kidney transplantation should be promptly analyzed and correct treatment should be applied. The combination immunodepressant treatments （FK506＋ MMF＋Pred） contributed to the early recovery of the renal function after transplantation.