Bloom R D, Doyle A M
Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Am J Transplant. 2006 Apr;6(4):671-9. doi: 10.1111/j.1600-6143.2006.01248.x.
Kidney disease is a commonly recognized complication of heart and lung transplantation and is associated with increased morbidity and mortality. While the spectrum of kidney disease in this population is wide-ranging, studies indicate that between 3% and 10% of these patients will ultimately develop end-stage renal disease (ESRD). This review examines the risk factors for both acute and chronic kidney injury, with a particular emphasis on the role of calcineurin inhibitor-mediated nephrotoxicity in both these settings. Against the background of current National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, we have further considered and recommended appropriate strategies for long-term management of kidney disease-related manifestations in heart and lung transplant recipients. Specific aspects addressed include retarding progressive renal injury and minimizing nephrotoxicity, as well as treatment of hypertension, hyperlipidemia and anemia. Finally, for patients in this population with advanced kidney disease, renal replacement therapy options are discussed. Based on the impact of chronic kidney disease on outcomes in both heart and lung recipients, we advocate early referral to a nephrologist for patients displaying evidence of significant renal dysfunction.
肾脏疾病是心肺移植常见的公认并发症，与发病率和死亡率增加相关。虽然该人群中的肾脏疾病谱广泛，但研究表明，这些患者中有3%至10%最终会发展为终末期肾病（ESRD）。本综述探讨了急性和慢性肾损伤的危险因素，特别强调了钙调神经磷酸酶抑制剂介导的肾毒性在这两种情况下的作用。在当前美国国家肾脏基金会肾脏病预后质量倡议（KDOQI）指南的背景下，我们进一步考虑并推荐了针对心肺移植受者肾脏疾病相关表现的长期管理的适当策略。涉及的具体方面包括延缓进行性肾损伤和将肾毒性降至最低，以及治疗高血压、高脂血症和贫血。最后，对于该人群中患有晚期肾脏疾病的患者，讨论了肾脏替代治疗方案。基于慢性肾脏病对心肺移植受者预后的影响，我们主张对于表现出明显肾功能不全证据的患者尽早转诊至肾病科医生处。
