Zaltzman Jeffrey S, Nash Michelle, Chiu Rick, Prasad Ramesh
Director of Renal Transplantation, Division of Nephrology, Dept of Medicine, University of Toronto, St Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada M5B 1W8.
Nephrol Dial Transplant. 2004 Apr;19(4):940-4. doi: 10.1093/ndt/gfg593.
Allograft nephropathy, regardless of aetiology, leads to progressive renal injury and eventual graft loss. In native kidney disease, treatment of hypertension, in particular with angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), has proven beneficial in retarding renal function decline. In the present study, we reviewed the clinical course of a renal transplant recipient cohort that was prescribed either an ACEi or ARB for biopsy-proven allograft nephropathy.
Patients were followed from the time of post-biopsy initiation of ACEi/ARB and were stratified based on biopsy findings. Outcomes of interest included safety, allograft survival, renal function and change in slope of renal function pre- and post-ACEi/ARB.
The 5 year allograft survival after biopsy diagnosis of allograft nephropathy was 83%. Serum creatinine was 191+/-97 (86-377) micromol/l at the time of biopsy and 228+/-102 (102-575) micromol/l at last follow-up. The slopes of reciprocal creatinine vs time were used to calculate the decline in renal function and were compared pre- and post-ACEi/ARB. The mean slope+/-SD was -0.06+/-0.21 l/micromol x 10(-3) per month in the 12 months prior to therapy and -0.03+/-0.09 l/micromol x 10(-3) per month following therapy. The absolute difference in slopes was 0.03 (P =<0.0001).
Treatment with ACEi/ARB may be beneficial in the management of allograft nephropathy.
同种异体移植肾病，无论病因如何，都会导致进行性肾损伤并最终导致移植肾丧失。在原发性肾脏疾病中，治疗高血压，特别是使用血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB），已被证明有助于延缓肾功能下降。在本研究中，我们回顾了一组肾移植受者的临床病程，这些患者因活检证实的同种异体移植肾病而被处方使用ACEi或ARB。
患者从活检后开始使用ACEi/ARB时起进行随访，并根据活检结果进行分层。感兴趣的结果包括安全性、移植肾存活率、肾功能以及ACEi/ARB治疗前后肾功能斜率的变化。
活检诊断为同种异体移植肾病后的5年移植肾存活率为83%。活检时血清肌酐为191±97（86 - 377）微摩尔/升，最后一次随访时为228±102（102 - 575）微摩尔/升。使用肌酐倒数与时间的斜率来计算肾功能下降情况，并对ACEi/ARB治疗前后进行比较。治疗前12个月的平均斜率±标准差为每月-0.06±0.21升/微摩尔×10⁻³，治疗后为每月-0.03±0.09升/微摩尔×10⁻³。斜率的绝对差值为0.03（P≤0.0001）。
使用ACEi/ARB治疗可能有助于同种异体移植肾病的管理。
