IgA肾病(immunoglobulin A nephropathy,IgAN)属于常见的原发性肾小球肾炎之一,也是终末期肾病(end-stage renal disease,ESRD)的主要病因之一。IgAN的治疗仍然存在挑战,干预相关的危险因素,可延缓疾病的进展。近年发现,高尿酸血症是IgA...IgA肾病(immunoglobulin A nephropathy,IgAN)属于常见的原发性肾小球肾炎之一,也是终末期肾病(end-stage renal disease,ESRD)的主要病因之一。IgAN的治疗仍然存在挑战,干预相关的危险因素,可延缓疾病的进展。近年发现,高尿酸血症是IgAN患者常见的临床特点,也是疾病进展的危险因素之一,但高尿酸血症与IgAN病理改变及疾病进展的关系仍不明确。因此,明确高尿酸血症与IgAN的关系具有重要的临床意义。本文从高尿酸血症在IgAN中的患病率、相关的发病机制与IgAN进展的关系及治疗靶点等方面进行了较为详尽的综述。展开更多
Kidney transplantation is the best option for kidney replacement therapy,even considering that most of the times the grafts do not survive as long as their recipients.In the Khalil et al's experience,published in ...Kidney transplantation is the best option for kidney replacement therapy,even considering that most of the times the grafts do not survive as long as their recipients.In the Khalil et al's experience,published in this issue of the Journal,they analyze their second kidney graft survival and describe those significant predictors of early loss.This editorial comments on the results and put in perspective that most of the times,long-term graft survival could be inadvertently jeopardized if the immunosuppressive therapy is reduced or withdrawn for any reason,and that it could happen frequently if the transplant physician intends to innovate with the clinical care without proper evidence-based data.展开更多
BACKGROUND The histopathological findings on the failing kidney allograft in the modern era is not well studied. In this study, we present our experience working with kidney transplant recipients with graft failure wi...BACKGROUND The histopathological findings on the failing kidney allograft in the modern era is not well studied. In this study, we present our experience working with kidney transplant recipients with graft failure within one year of the biopsy.AIM To report the histopathological characteristics of failed kidney allografts in the current era of immunosuppression based on the time after transplant, cause of the end-stage renal disease and induction immunosuppressive medications.METHODS In a single-center observational study, we characterized the histopathological findings of allograft biopsies in kidney transplant recipients with graft failure within one year after the biopsy.RESULTS We identified 329 patients with graft failure that met the selection criteria between January 1, 2006 and December 31, 2016. The three most common biopsy findings were interstitial fibrosis and tubular atrophy(IFTA, 53%), acute rejection (AR, 43%) and transplant glomerulopathy(TG, 33%). Similarly, the three most common causes of graft failure based on the primary diagnosis were AR(40%),TG(17%), and IFTA(13%). Most grafts failed within two years of post-transplant(36%). Subsequently, approximately 10%-15% of grafts failed every two years: >2-4 years(16%), > 4-6 years(13%), > 6-8 years(11%), > 8-10 years(9%) and > 10 years(16%). AR was the most common cause of graft failure in the first six years(48%), whereas TG was the most prevalent cause of graft failure after 6 years(32%) of transplant.CONCLUSION In the current era of immunosuppression, AR is still the most common cause of early graft failure, while TG is the most prevalent cause of late graft failure.展开更多
文摘IgA肾病(immunoglobulin A nephropathy,IgAN)属于常见的原发性肾小球肾炎之一,也是终末期肾病(end-stage renal disease,ESRD)的主要病因之一。IgAN的治疗仍然存在挑战,干预相关的危险因素,可延缓疾病的进展。近年发现,高尿酸血症是IgAN患者常见的临床特点,也是疾病进展的危险因素之一,但高尿酸血症与IgAN病理改变及疾病进展的关系仍不明确。因此,明确高尿酸血症与IgAN的关系具有重要的临床意义。本文从高尿酸血症在IgAN中的患病率、相关的发病机制与IgAN进展的关系及治疗靶点等方面进行了较为详尽的综述。
文摘Kidney transplantation is the best option for kidney replacement therapy,even considering that most of the times the grafts do not survive as long as their recipients.In the Khalil et al's experience,published in this issue of the Journal,they analyze their second kidney graft survival and describe those significant predictors of early loss.This editorial comments on the results and put in perspective that most of the times,long-term graft survival could be inadvertently jeopardized if the immunosuppressive therapy is reduced or withdrawn for any reason,and that it could happen frequently if the transplant physician intends to innovate with the clinical care without proper evidence-based data.
文摘BACKGROUND The histopathological findings on the failing kidney allograft in the modern era is not well studied. In this study, we present our experience working with kidney transplant recipients with graft failure within one year of the biopsy.AIM To report the histopathological characteristics of failed kidney allografts in the current era of immunosuppression based on the time after transplant, cause of the end-stage renal disease and induction immunosuppressive medications.METHODS In a single-center observational study, we characterized the histopathological findings of allograft biopsies in kidney transplant recipients with graft failure within one year after the biopsy.RESULTS We identified 329 patients with graft failure that met the selection criteria between January 1, 2006 and December 31, 2016. The three most common biopsy findings were interstitial fibrosis and tubular atrophy(IFTA, 53%), acute rejection (AR, 43%) and transplant glomerulopathy(TG, 33%). Similarly, the three most common causes of graft failure based on the primary diagnosis were AR(40%),TG(17%), and IFTA(13%). Most grafts failed within two years of post-transplant(36%). Subsequently, approximately 10%-15% of grafts failed every two years: >2-4 years(16%), > 4-6 years(13%), > 6-8 years(11%), > 8-10 years(9%) and > 10 years(16%). AR was the most common cause of graft failure in the first six years(48%), whereas TG was the most prevalent cause of graft failure after 6 years(32%) of transplant.CONCLUSION In the current era of immunosuppression, AR is still the most common cause of early graft failure, while TG is the most prevalent cause of late graft failure.
