肾移植术后常见的复发性肾小球疾病(一)

Posttransplant recurrence glomerulonephritis

各种引起终末期肾病常见的原发性和继发性肾小球疾病均可在肾移植术后复发。常见的复发性原发性肾小球疾病包括IgA肾病、局灶节段性肾小球硬化、特发性膜性肾病和膜增生性肾小球肾炎;常见的复发性继发性肾小球疾病则包括狼疮性肾炎、过敏性紫癜性肾炎、肾淀粉样变性、轻链沉积病、原纤维性/免疫管状肾小球肾炎、混合性冷球蛋白血症性肾病、糖尿病肾病及血管炎肾损害等。由于各移植中心开展移植肾活检的策略不同,因而各移植中心报道的不同病因引起复发性肾小球疾病的发生率也不一致。复发性肾小球疾病患者的病情轻重不一,但无论临床症状还是病理改变一般均轻于自体肾疾病;致使疾病易复发的危险因素各有不同,但一般年轻、自体肾脏疾病重、进展迅速、活体供肾……易致疾病复发;一些疾病经移植前强化治疗可以减少复发;移植后早期确诊疾病复发,且采取积极的治疗措施,能使一些复发性疾病受者临床获益。总之,尽管多种原发性和继发性肾小球疾病在肾移植后均能复发,导致移植肾再次受损,但肾移植仍不失为终末期肾病最有效的疗法之一。

All forms of primary and secondly GN may recur after kidney transplantation. The common primary glomerular diseases include IgA nephritis （IgAN） , focal segmental glomerulosclerosis （FSGS） , membranous nephropathy （MN）, and membranoproliferative GN （MPGN）. The common secondly glomerular diseases include lupus nephritis, Henoeh-Schonlein nephritis, amyloidosis, light-chain deposition disease, fibrillary/immunotactoid glomerulonephritis, eryoglobulinemic nephritis, diabetic nephropathy, and small vessel vaseulitis. The rate of recurrence differed in different transplant center because of the different indication for the renal allograft biopsy. Although the clinical and pathological character of these diseases were different, the recurrent diseases were better than the native glomerular diseases. The high risks for the recurrence of glomerular diseases included young receipts, living donor, rapid progression to ESRD et al. The intensive therapy before operation can decrease the risk of recurrence. Early diagnosis and the treatment can decrease the injury of the recurrent glomerular disease. Although the primary and secondly GN may recur after kidney transplantation and potentially jeopardize the survival of the graft, most of patients can be considered suitable candidates for a renal transplant.