肾移植术后IgA肾病复发

张寅生; 彭形彤; 杨庭楷; 邢家利; 文进; 纪志刚

doi:10.3969/j.issn.1674-7445.2022.05.006

肾移植术后IgA肾病复发

doi: 10.3969/j.issn.1674-7445.2022.05.006

100730 北京，中国医学科学院北京协和医学院北京协和医院泌尿外科（张寅生、彭形彤、杨庭楷、文进、纪志刚），肝脏外科（邢家利）

基金项目:

中央级公益性科研院所基本科研业务费临床与转化医学研究基金 2019XK320027

详细信息

作者简介:

通讯作者:
文进，Email：wjpumch@163.com

纪志刚，Email：jzgjxmc@163.com

中图分类号: R617, R692.6
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出版历程
- 收稿日期: 2022-04-22
- 网络出版日期: 2022-09-14
- 刊出日期: 2022-09-15

Recurrence of IgA nephropathy after kidney transplantation

Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China

More Information

Corresponding author: Wen Jin, Email: wjpumch@163.com; Ji Zhigang, Email: jzgjxmc@163.com

摘要

摘要: IgA肾病（IgAN）是常见的原发性肾小球肾炎之一，也是导致终末期肾病的重要危险因素。肾移植是IgAN导致的终末期肾病患者的首选治疗方式，但肾移植术后仍存在IgAN复发风险。目前有关肾移植术后IgAN复发的相关研究进展缓慢。IgAN复发的发病机制尚未明确，其病理表现不具备特异性，确诊仍依赖于肾活组织检查，且尚未见有效的复发性IgAN防治方案。本文主要从肾移植术后IgAN复发的发病机制、诊断、危险因素及治疗手段等方面介绍肾移植术后IgAN复发的最新进展，以期为临床肾移植术后IgAN复发的防治提供参考，改善肾移植受者的预后。
- 肾移植 /
- IgA肾病（IgAN） /
- 终末期肾病 /
- 复发 /
- 半乳糖缺陷型IgA1（Gd-IgA1） /
- 蛋白尿 /
- 糖皮质激素 /
- 免疫抑制药
Abstract: IgA nephropathy (IgAN) is one of the common primary glomerulonephritis, which is also an important risk factor for end-stage renal disease. Kidney transplantation is the optimal treatment for end-stage renal disease induced by IgAN, whereas there is still a risk of recurrence of IgAN after kidney transplantation. At present, research progress upon IgAN recurrence after kidney transplantation is relatively lacking. The pathogenesis of IgAN recurrence remains elusive, and its pathological manifestations are not specific. The diagnosis of IgAN recurrence still depends on renal biopsy. Besides, no effective prevention and treatment are available for recurrent IgAN. In this article, research progress on IgAN recurrence after kidney transplantation was illustrated from the perspectives of pathogenesis, diagnosis, risk factors and treatment, aiming to provide reference for clinical prevention and treatment of IgAN recurrence after kidney transplantation and improve clinical prognosis of kidney transplant recipients.
- Kidney transplantation /
- IgA nephropathy (IgAN) /
- End-stage renal disease /
- Recurrence /
- Galactose-deficient IgA1 (Gd-IgA1) /
- Proteinuria /
- Glucocorticoid /
- Immunosuppressant

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表 1 IgAN牛津病理分型^[28]

Table 1. Oxford pathological classification of IgAN

病理特征	定义	评分
M	肾小球系膜区有≥4个系膜细胞	M0：≤50%系膜区细胞增多 M1： > 50%系膜区细胞增多
E	肾小球毛细血管内细胞增多	E0：无 E1：有
S	不涉及整个肾小球的粘连或硬化	S0：无 S1：有
T	皮质区小管萎缩与间质纤维化的比例	T0：≤25% T1：26%~50% T2： > 50%
C	细胞和（或）成纤维细胞新月体的比例	C0：无 C1： < 25% C2：≥25%

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