Kato T, Sato Y, Yamamoto S, Takeishi T, Hirano K, Kobayashi T, Hara Y, Watanabe T, Shirai Y, Hatakeyama K
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Transplant Proc. 2004 Oct;36(8):2321-3. doi: 10.1016/j.transproceed.2004.06.057.
Type C liver cirrhosis is often associated with a nephrotic syndrome secondary to membranoproliferative glomerulonephritis. Liver transplantation in such patients may sometimes worsen viremia, causing renal dysfunction upon the introduction of immunosuppressive drugs. We present a case of a patient whose proteinuria decreased after liver transplantation. The patient was a 49-year-old male who had been followed due to chronic hepatitis type C from 1984. From 1999 he was diagnosed as having nephrotic syndrome. We performed a living related liver transplant on August 21, 2001. An intraoperative renal biopsy revealed the histology to show membranoproliferative glomerulonephritis. The volume of proteinuria was 2 to 11 g/day before surgery. After surgery it varied from 6 to 10 g/day, gradually decreasing to 1 to 2 g/day. One of the causes of reduced proteinuria may be alleviation of membranoproliferative glomerulonephritis by immunosuppression. But from the view that the recovery of the renal function followed the recovery of liver function, the major effect may have been alleviated hepatorenal syndrome.
C型肝硬化常与继发于膜增生性肾小球肾炎的肾病综合征相关。在此类患者中进行肝移植有时可能会使病毒血症恶化，在引入免疫抑制药物后导致肾功能障碍。我们报告一例患者，其肝移植后蛋白尿减少。该患者为49岁男性，自1984年起因丙型慢性肝炎接受随访。从1999年起，他被诊断为患有肾病综合征。我们于2001年8月21日进行了活体亲属肝移植。术中肾活检显示组织学表现为膜增生性肾小球肾炎。术前蛋白尿的量为每天2至11克。术后蛋白尿的量在每天6至10克之间变化，逐渐减少至每天1至2克。蛋白尿减少的原因之一可能是免疫抑制减轻了膜增生性肾小球肾炎。但从肾功能恢复跟随肝功能恢复这一观点来看，主要作用可能是减轻了肝肾综合征。
