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肾移植术后的多种并发症

[Multiple complications after renal transplantation].

作者信息

Manrique J, Rossich E, Hernández Sierra A

机构信息

Servicio de Nefrología, Clínica Universitaria de Navarra, Pamplona.

出版信息

Nefrologia. 2004;24 Suppl 3:26-9.

Abstract

This is the case of a 32-year-old male patient, diagnosed with end stage renal disease secondary to a focal and segmental glomerulonephritis. After four years of haemodialysis, he received a renal graft from a cadaveric donor. During the following sixteen years, he developped many different complications. In the early post-transplant period, he developed a severe acute tubular necrosis and two episodes of acute rejection took place, both of them with later recovery. Among the outstanding infectious complications were a virus herpes zoster dorsal infection and a Pseudomonas aeruginosa nosocomial pneumonia. Twelve months later, a series of severe digestive complications took place: cholecystitis that required cholecystectomy, pancreatic pseudocyst which required laparotomy because of an abdominal complication, two separate episodes of upper digestive bleeding that finally required gastric surgery, and an hemorrhagic subphrenic abscess that required a second laparotomy. Currently he has developed a calcified chronic pancreatitis. Moreover, metabolic complications must be mentioned carbohydrate intolerance, cataracts and an avascular bone necrosis, all of them closely related to the immunosuppressive therapy. In spite of these multiple complications, he mantains a good renal function and his quality of life is acceptable.

摘要

这是一名32岁男性患者的病例,他被诊断为局灶节段性肾小球肾炎继发的终末期肾病。经过四年的血液透析后,他接受了来自尸体供体的肾移植。在接下来的十六年里,他出现了许多不同的并发症。移植后的早期,他发生了严重的急性肾小管坏死,并出现了两次急性排斥反应,两次均随后恢复。在显著的感染性并发症中,有一次带状疱疹背部感染和一次铜绿假单胞菌医院获得性肺炎。十二个月后,发生了一系列严重的消化系统并发症:需要进行胆囊切除术的胆囊炎、因腹部并发症需要剖腹手术的胰腺假性囊肿、最终需要胃部手术的两次单独的上消化道出血发作,以及需要第二次剖腹手术的膈下出血性脓肿。目前他已发展为钙化性慢性胰腺炎。此外,还必须提及代谢并发症,即碳水化合物不耐受、白内障和缺血性骨坏死,所有这些都与免疫抑制治疗密切相关。尽管有这些多种并发症,但他仍保持良好的肾功能,生活质量尚可。

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