Paul L C, de Fijter J H
Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands.
Transplant Proc. 2004 Mar;36(2 Suppl):224S-228S. doi: 10.1016/j.transproceed.2004.01.005.
The most practical way to assess and to quantitate the renal function in renal transplant patients is the Cockcroft-Gault equation or an equation used to estimate the glomerular filtration rate (GFR), derived from the Modification of Diet in Renal Disease study. Chronic cyclosporine (CsA) nephrotoxicity causes structural lesions in the kidney and an impairment in the GFR. Determining the composition of the interstitial collagens may be helpful to establish the diagnosis. CsA trough levels are a poor indicator of drug exposure; drug exposure should be quantitated using more accurate methods. Although routine biopsies often show histopathological evidence of structural damage, the excellent kidney graft half-life and the documentation that the creatinine clearance usually remains stable over years in CsA-treated renal transplant patients suggest that its use in kidney transplant patients does not inexorably lead to graft failure. Protocol biopsies show a high incidence of chronic structural CsA toxicity but transplant nephrectomies show that CsA nephrotoxicity as the sole cause of graft loss is extremely rare.
评估和量化肾移植患者肾功能最实用的方法是Cockcroft-Gault方程或用于估计肾小球滤过率（GFR）的方程，该方程源自肾脏疾病饮食改良研究。慢性环孢素（CsA）肾毒性会导致肾脏结构损伤和GFR受损。确定间质胶原的组成可能有助于诊断的确立。CsA谷浓度不是药物暴露的良好指标；应使用更准确的方法来量化药物暴露。虽然常规活检常显示结构损伤的组织病理学证据，但肾移植的良好半衰期以及CsA治疗的肾移植患者肌酐清除率通常多年保持稳定的记录表明，在肾移植患者中使用CsA并不必然导致移植失败。方案活检显示慢性CsA结构性毒性的发生率很高，但移植肾切除术表明，CsA肾毒性作为移植肾丢失的唯一原因极为罕见。
