Kamar N, Allard J, Ader J L, Rostaing L
Multiorgan Transplant Unit, Toulouse University Hospital, Toulouse, France.
Transplant Proc. 2004 Mar;36(2 Suppl):248S-250S. doi: 10.1016/j.transproceed.2003.12.040.
The glomerular filtration rate (GFR) may increase after oral protein overload or after an amino acid infusion. Renal functional reserve (RFR) is defined as the difference between the poststimulation and the baseline glomerular filtration rate. RFR has been studied in transplant patients. The results have been conflicting because RFR may be affected by donor age, the time from transplantation, the type of immunosuppression, the basal GFR, the body surface area, and the presence of calcium channel blocker therapy. We observed that during the first year posttransplantation renal recipients maintained on cyclosporine (CsA) therapy retain a level of RFR that represents approximately 30% of the baseline GFR. Moreover, hypertensive cyclosporine treated renal transplant patients on calcium channel blocker therapy do not exhibit permanent glomerular hyperfiltration until 8 months posttransplantation. Finally, both renal and heart transplant patients on cyclosporine therapy possess renal reserve, but the single renal graft in renal transplant patients shows a proportionally higher baseline GFR and a better ability to exhibit a RFR than the two native kidneys in heart transplant patients. Many studies, although not all, have documented a positive RFR in both children and adult cyclosporine-treated kidney graft recipients, demonstrating that hyperfiltration is not the rule following single kidney transplantation.
口服蛋白质负荷过重或输注氨基酸后，肾小球滤过率（GFR）可能会升高。肾功能储备（RFR）定义为刺激后与基线肾小球滤过率之间的差值。已对移植患者的RFR进行了研究。结果存在矛盾，因为RFR可能受供体年龄、移植后的时间、免疫抑制类型、基础GFR、体表面积以及是否接受钙通道阻滞剂治疗的影响。我们观察到，在移植后的第一年，接受环孢素（CsA）治疗的肾移植受者的RFR水平约占基线GFR的30%。此外，接受钙通道阻滞剂治疗的高血压环孢素治疗肾移植患者直到移植后8个月才出现永久性肾小球高滤过。最后，接受环孢素治疗的肾移植和心脏移植患者都具有肾储备，但肾移植患者的单个肾移植肾单位的基线GFR相对较高，且与心脏移植患者的两个天然肾脏相比，表现出RFR的能力更强。许多研究（虽然并非全部）都记录了儿童和成人环孢素治疗的肾移植受者存在阳性RFR，表明单肾移植后并非一定会出现高滤过。
