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目的探讨肾移植受者蛋白尿的病因和临床对策。方法对广州医学院第二附属医院2006年7月至2010年8月随访中出现蛋白尿的103例肾移植受者进行移植肾穿刺活组织检查(简称活检),根据病理学诊断进行相应的临床治疗。结果 103例移植肾活检中急性排斥反应32例,慢性排斥反应25例,肾小球肾炎30例(其中IgA肾病12例),肾小管-间质损伤7例,其他9例(包括肾小球轻微病变6例,糖尿病肾损害3例)。经过分类治疗后70.9%(73/103)受者蛋白尿逆转,肾功能维持稳定。结论排斥反应和原有肾疾病复发是导致肾移植受者蛋白尿的主要原因,移植肾活检是早期明确蛋白尿病因的有效手段,根据病理学诊断结果进行分类治疗可取得良好临床效果。
Objective To investigate the etiology and clinical strategy of proteinuria in renal transplant recipients. Methods A total of 103 renal transplant recipients with proteinuria during follow-up from July 2006 to August 2010 at the Second Affiliated Hospital of Guangzhou Medical College underwent renal biopsy (referred to as biopsy), according to the pathological diagnosis of the corresponding clinical treatment. Results A total of 32 cases of acute rejection, 32 cases of chronic rejection, 30 cases of glomerulonephritis (including 12 cases of IgA nephropathy), 7 cases of tubulointerstitial injury and 9 cases of other 9 cases (including glomeruli 6 cases of minor lesions, 3 cases of diabetic nephropathy). After classification treatment, 70.9% (73/103) recipients reversed proteinuria, and renal function remained stable. CONCLUSIONS: Rejection and the recurrence of original renal disease are the main causes of proteinuria in renal transplant recipients. Transplantation renal biopsy is an effective means to clarify the etiology of proteinuria in the early stage. According to the results of pathological diagnosis, good clinical results can be obtained.