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肾移植术后Ⅰ型原发性高草酸尿症复发致移植肾功能不全的多学科综合诊疗

王於尘 严紫嫣 邓文锋 夏仁飞 曾文利 罗佳 徐健 苗芸

王於尘, 严紫嫣, 邓文锋, 等. 肾移植术后Ⅰ型原发性高草酸尿症复发致移植肾功能不全的多学科综合诊疗[J]. 器官移植, 2021, 12(1): 77-82. doi: 10.3969/j.issn.1674-7445.2021.01.012
引用本文: 王於尘, 严紫嫣, 邓文锋, 等. 肾移植术后Ⅰ型原发性高草酸尿症复发致移植肾功能不全的多学科综合诊疗[J]. 器官移植, 2021, 12(1): 77-82. doi: 10.3969/j.issn.1674-7445.2021.01.012
Wang Yuchen, Yan Ziyan, Deng Wenfeng, et al. Multi-disciplinary team on renal allograft dysfunction induced by recurrence of primary hyperoxaluria type I after renal transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(1): 77-82. doi: 10.3969/j.issn.1674-7445.2021.01.012
Citation: Wang Yuchen, Yan Ziyan, Deng Wenfeng, et al. Multi-disciplinary team on renal allograft dysfunction induced by recurrence of primary hyperoxaluria type I after renal transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(1): 77-82. doi: 10.3969/j.issn.1674-7445.2021.01.012

肾移植术后Ⅰ型原发性高草酸尿症复发致移植肾功能不全的多学科综合诊疗

doi: 10.3969/j.issn.1674-7445.2021.01.012
基金项目: 

国家自然科学基金 82070770

广东省自然科学基金 2020A1515010674

广州市科技计划项目 201803010109

南方医院院长基金 2018B009

南方医院院长基金 2018C003

大学生创新创业训练计划项目 202012121046

大学生创新创业训练计划项目 X202012121239

王於尘和严紫嫣为共同第一作者
详细信息
    通讯作者:

    苗芸,女,1978年生,博士,主任医师,研究方向为肾移植,Email:miaoyunecho@126.com

  • 中图分类号: R617, R596

Multi-disciplinary team on renal allograft dysfunction induced by recurrence of primary hyperoxaluria type I after renal transplantation

More Information
  • 摘要:   目的  探讨肾移植术后Ⅰ型原发性高草酸尿症(PH)复发的临床特点和多学科综合诊疗(MDT)的经验。  方法  对1例接受同种异体肾移植手术后不明原因移植肾功能短期内迅速下降的病例进行MDT讨论,总结MDT在诊断罕见遗传性疾病以及提高肾移植受者长期存活中的作用。  结果  经MDT讨论,患者确诊为Ⅰ型PH复发,排除排斥反应后恢复常规免疫抑制方案,嘱大量饮水,予优质蛋白和低磷饮食、维生素B6、钙剂等保守治疗措施并积极防治并发症。患者移植肾功能恶化延缓,但仍在肾移植术后5个月恢复规律血液透析至投稿日。结论肾移植术后Ⅰ型PH复发较为罕见,临床主要表现为复发性肾结石,移植肾功能下降,且并发症多,患者预后不良。通过MDT讨论患者病情,明确诊断,确定最佳治疗方案,延缓了病情进展,改善了患者预后。

     

  • 图  1  肾移植受者Scr水平和移植肾超声图像变化趋势

    注:标号A~F节点对应A~F图的移植肾超声图像。

    Figure  1.  The variation trend of Scr levels and sonographic images of the transplant kidney in the renal transplant recipient

    图  2  移植肾组织病理学表现(苏木素-伊红,×400)

    注:A图为移植肾组织病理学图片,可见肾小管管腔内针状草酸盐结晶;B图为偏振光下的移植肾组织病理学图片,可见草酸盐结晶呈双折射现象。

    Figure  2.  Histopathological findings of transplant kidney

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出版历程
  • 收稿日期:  2020-10-27
  • 网络出版日期:  2021-01-19
  • 刊出日期:  2021-01-19

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