摘要
目的 探讨移植肾IgA肾病的病理特征、临床表现及预后。方法 回顾分析移植肾穿刺活检病理及临床资料。结果 3例IgA肾病 ,1例为复发性膜增殖型 ,2例为复发 /新发性系膜增殖型 ,临床表现主要是镜下血尿、轻度蛋白尿、或 /和高血压、高脂血症 ;病理改变与普通人群的IgA肾病相同 ,此外存在多灶性肾小管萎缩及间质纤维化 ;其对治疗的反应与病理改变密切相关 ,以双嘧达莫、小剂量华法林及雷公藤多甙治疗 2年 ,2例系膜增殖型者肾功能稳定 ,膜增殖型的 1例治疗 2年半后血肌酐上升。结论 移植肾IgA肾病复发迅速 ,其进展速度及治疗效果与病理分型和病变程度密切相关 。
Objective To study the clinical and histopathologic characters of recurrent and de novo IgA nephropathy (IgAN) following cadaveric kidney transplantation, and investigate the prognosis. Method Three patients were diagnosed as having transplant IgAN from 36 patients with abnormal renal function (proteinuria, hematuria or/and elevated creatinine) by renal graft biopsy and histopathologic analysis . The patients were treated with dipyridamole, low dose warfarin and tripterygium wifordii and the therapeutic effects were observed. Results Three patients were respectively diagnosed as having de novo/recurrent membrano preliferative IgAN (lesion of grade Ⅲ) with moderate chronic allograft nephropathy at 30th month postoperatively, recurrent mesangial proliferative IgAN (grade Ⅱ) with mild chronic allograft nephropathy at 18th month postoperatively and de novo/recurrent mesangial proliferative IgAN (gradeⅡ) with mild chronic allograft nephropathy at 14th month postoperatively. All of then were treated with dipyridamole, low dose warfarin and tripterygium wifordii for 24 months, and unchanged basic immunosuppressive regimens (including CsA, MMF or Aza and Pred). The 3 patients kept a stable serum creatinie, improved macroscopic hematuria, and some amount of proteinuria during the treatment, but the first one with membrano preliferative IgAN had elevated serum creatinine (from 120 150?μmol/L up to 180 200?μmol/L) at 30th month maintenance of the treatment (60 months postoperation). Conclusions Recurrent or de novo IgAN in renal allograft occurred quickly, efficacious treatment had been not searched out yet, and prognosis had a close relationship with degree of histopathologic lesion, classification of IgAN.
出处
《中华器官移植杂志》
CAS
CSCD
北大核心
2001年第1期8-10,共3页
Chinese Journal of Organ Transplantation
