肾移植后肾坏死与肾移植排斥反应的病理学表现与变化

Pathology performance and changes of kidney necrosis and rejection after kidney transplantation

背景:肾移植后受者定期行移植肾组织活检,在移植肾出现问题的早期进行正确的病理诊断,选择合适的治疗,是使移植肾长期存活的关键。目的:总结肾移植后肾坏死与肾移植排斥反应的病理学表现与变化。方法:由作者应用计算机检索维普数据库、Pubmed数据库中与肾移植后肾坏死与肾移植排斥反应有关的文献,检索时限为1998-01/2009-10。对资料进行初审,并查看每篇文献后的引文。结果与结论:共16篇文献符合标准。移植后慢性肾脏损害的病理类型包括慢性排斥反应,系膜病变,新月体肾炎,膜性肾病,Ig肾病,溶血性尿毒综合征。移植后慢性肾脏损害最常见的病理类型为慢性排斥反应,与慢性排斥反应相关的因素可能包括:供肾年龄,急性排斥反应发生率,移植肾功能延迟恢复及CMV感染。高血压和蛋白尿对移植肾的远期预后也有重要影响。移植肾的病理改变复杂多样,结合移植肾穿刺病理活检结果和临床分析进行准确诊断,成功率高、安全性好,对肾移植后难以根据临床化验资料作出准确判断肾脏损害及治疗方案的选择有着重要的指导意义。

BACKGROUND:The key for the survival of the transplant kidney is to provide regularly renal biopsy,correct pathological diagnosis and appropriate treatment for the recipients in the early stage when the problems of the transplant kidney are discovered.OBJECTIVE:To summarize the pathology performance and changes of kidney necrosis and rejection after kidney transplant.METHODS:A computer-based online search of VIP Database and PubMed database was performed for the relevant articles on kidney necrosis and rejection after kidney transplant published from January 1998 to October 2009.The collected articles were preliminarily reviewed;the references of each article were checked.RESULTS AND CONCLUSION:A total of 16 articles were retained according to the inclusion criteria.The pathological types of chronic kidney damage after transplantation include chronic rejection,mesangial lesions,crescentic glomerulonephritis,membranous nephropathy,Ig nephropathy and hemolytic uremic syndrome.Chronic rejection is the most common pathological type of chronic kidney damage after transplantation;the factors related to chronic rejection may include:donor age,the incidence of acute rejection,delayed graft function recovery and CMV infection.Hypertension and proteinuria have important effects on the long-term prognosis of transplanted kidney.Pathological changes in transplanted kidney are complex and diverse;the combined diagnosis method based on the results of renal puncture biopsy and clinical analysis has high success rate and good safety.It has an important guiding sense to the judgments of kidney damage after renal transplantation based on clinical laboratory data and the selection of treatment options.