横纹肌溶解症合并急性肾功能衰竭供体的肾脏功能维护

Maintenance of kidney function in donors with rhabdomyolysis and acute renal failure

目的探讨横纹肌溶解症合并急性肾功能衰竭(ARF)供体的肾脏功能维护方法。方法回顾性分析中山大学附属第一医院东院2012年1月至2016年12月器官捐献供体中,因横纹肌溶解症导致供体ARF的器官功能维护和肾移植临床资料。常规维护包括血流动力学处理、纠正低氧血症、稳定内环境;针对横纹肌溶解症和急性肾损伤的特殊维护包括扩容治疗、碱化尿液、血浆置换和肾脏替代疗法(RRT)。结果 15例供体因横纹肌溶解症导致ARF,供体血肌酸激酶峰值浓度为(15 569±8597)U/L,血浆肌红蛋白峰值浓度为(37 092±42 100)μg/L,血清肌酐峰值浓度为(422±167)μmol/L。常规维护方法包括处理原发疾病、中度扩容和碱化尿液。其中3例接受血浆置换治疗,2例行RRT,1例接受体外膜肺氧合治疗。30例受体,肾移植术后6例发生移植肾功能延迟恢复。随访15~48个月,人肾均存活。肾移植术后12、24个月肾小球滤过率分别为(68.1±15.3)和(70.3±14.6)ml/(min·1.73m^2)。结论横纹肌溶解症合并ARF供体,经适当维护后,供肾移植可获得良好功能。

Objective To explore the methods of maintenance of kidney function in donors with rhabdomyolysis and acute renal failure （ARF）.Methods Kidney donors with ARF caused by rhabdomyolysis and the methods of donor maintenance from January 2012 to December 2016 were retrospectively reviewed. The routine maintenance methods include hemodynamic treatment, correcting hypoxia and stabilizing the balance of fluids and electrolytes. The specific strategies of rhabdomyolysis and ARF include volume expansion, urinary alkalinization, plasmapheresis and renal replacement therapy （RRT）.Results Fifteen donors suffered from rhabdomyolysis and ARF were enrolled in the present study. The peak level of creatinine kinase serum myoblobin and serum creatinine were （15 569±8597） U/L, （37 092±42 100） μg/L and （422±167） μmol/L, respectively. Three donors received plasmapheresis therapy （1-2 sessions）, 2 donors received RRT and 1 donor received extra-corporeal membrane oxygenation treatment. Kidneys from these donors were transplanted into 30 recipients, among which delayed graft function was found in 6 patients. With a follow-up to 15-48 months, all patients and renal grafts survived. The mean of glomerular filtration rate were （68.1±15.3） and （70.3±14.6） ml/ （min·1.73 m^2）, respectively at 12 and 24 month after transplantation.Conclusion Kidneys donors with ARF and rhabdomyolysis had an excellent short-term outcome after appropriate maintenance.