他克莫司替换环孢素A治疗溶血性尿毒综合征1例

Cyclosporin A instead of Tacrolimus for treatment of hemolytic uremic syndrome in a kidney transplant recipient

回顾性分析吉林大学第一医院收治的1例肾移植后移植肾功能异常患者的临床资料,患者男,45岁,病理检查确诊为溶血性尿毒综合征,肾移植后采用以环孢素A为主的免疫抑制方案。肾移植后1年半,乏力1周,发现血肌酐升高1d入院。入院后第1天接受移植肾穿刺活检,行移植肾病理检查。病理结果回报前应用甲强龙按可疑急性排异反应冲击治疗2d,环孢素A和硫唑嘌呤未作调整。C4d免疫组化结果为肾小管周围毛细血管和肾小球毛细血管阴性,病理诊断符合急性免疫抑制剂肾毒性。病理结果回报后,停止甲强龙冲击,同时停用环孢素A,改服他克莫司,剂量为2mg/d;将硫唑嘌呤更换为相对不良反应更小的霉酚酸酯;口服泼尼松,20mg/d。观察更换免疫抑制剂后的移植肾功能变化,同时监测血常规变化。结果显示经上述免疫抑制剂调整1周后,患者的移植肾功能开始明显好转,治疗期间出现血红蛋白降低、血小板减少等溶血性尿毒综合征的改变。提示移植肾病理活检是诊断溶血性尿毒综合征的最重要手段,且调整免疫抑制剂,用他克莫司替换环孢素A治疗肾移植后溶血性尿毒综合征效果确切。

A patient with impaired kidney function after kidney transplantation and received treatment at the First Hospital of Jilin University was retrospective analyzed.The patient was male,45 years old,and was diagnosed hemolytic uremic syndrome by transplanted kidney biopsy.The patient received cyclosporine A（CsA） as maintenance centered immunosuppression therapy postoperatively.He was admitted because of 1 week acratia followed by 1 day increased serum creatinine level at 1.5 years after transplantation.At 1 day after admission,he was received renal needle biopsy,and underwent 2 days Prednisolone treatment.After hemolytic-uremic syndrome was diagnosed,CsA was transferred to Tacrolimus（Fk506） with dose of 2 mg/d,and Azathioprine was replaced by mycophenolate,Prednisone was taken orally for 20 mg/d.The function of the transplanted kidney and the change of routine blood tests were observed.After 1 week treatment of the changed immunosuppression therapy,the function of the transplanted kidney was improved obviously,and the hemoglobin and platelets was decreased during the treatment.The results demonstrated that kidney biopsy is a key method to diagnose hemolytic-uremic syndrome,and adjustment of immunosuppressive agents,replacing CsA with FK506 are effective for postoperative hemolytic-uremic syndrome.