Requião-Moura Lúcio R, Moscoso-Solorzano Grace T, Franco Marcello F, Ozaki Kikumi S, Pacheco-Silva Alvaro, Kirsztajn Gianna Mastroianni, Câmara Niels O S
Laboratory of Clinical and Experimental Immunology, Nephrology Division, Universidade Federal de São Paulo, UNIFESP, São Paulo, Brazil.
Clin Transplant. 2007 May-Jun;21(3):363-70. doi: 10.1111/j.1399-0012.2007.00650.x.
Little data are available concerning post-transplantation glomerulonephritis (PTx-GN) and its prognostic factors associated with graft outcomes.
We retrospectively evaluated patients with de novo and recurrent PTx-GN to identify the factors associated with their negative impact on graft and patient outcomes. PTx-GN was diagnosed in 55 patients, wherein 17 (31%) had recurrent glomerulonephritis (GN) and 16 (29%) had de novo.
Our enrolled population consisted of 34 +/- 13.7-yr-old male patients (72%), on hemodialysis for a median of 18 months (0-204) and mainly grafted from living donors (76%). The median onset time of proteinuria and hematuria was 50 d (10-2160) and 30 d (4-1170), respectively. One-yr graft survival rates after PTx-GN diagnosis was 64%. The most frequent de novo GN was membranous GN (26%), while focal segmental glomerulosclerosis was the most frequent recurrent GN (41%), with a very early onset (median of three months). One-yr graft survival was better in the recurrent disease than in the de novo patients, 76% vs. 55% (p = 0.24). The best predictor factors that correlated with graft survival were: proteinuria <3.5 g [relative risk (RR) = 0.24, p = 0.017], serum creatinine below 2.0 mg/dL (RR = 0.06, p = 0.016) at the time of biopsy and the use of angiotensin-converting enzyme inhibitors (ACEI) (RR = 0.12, p = 0.005). The use of ACEI markedly improved one-yr graft survival rates (92% vs. 47%, p < 0.001).
PTx-GN has a strong negative impact on kidney graft survival. De novo GN appears to have a poorer prognosis than the recurrent type. Patients who used ACEI showed a better survival rate in the follow-up.
关于移植后肾小球肾炎（PTx - GN）及其与移植肾预后相关的危险因素的数据较少。
我们回顾性评估了新发和复发性PTx - GN患者，以确定对移植肾和患者预后产生负面影响的相关因素。55例患者被诊断为PTx - GN，其中17例（31%）为复发性肾小球肾炎（GN），16例（29%）为新发。
我们纳入的患者群体为34±13.7岁的男性患者（72%），接受血液透析的中位时间为18个月（0 - 204个月），主要接受活体供肾移植（76%）。蛋白尿和血尿的中位发病时间分别为50天（10 - 2160天）和30天（4 - 1170天）。PTx - GN诊断后1年移植肾存活率为64%。最常见的新发GN是膜性GN（26%），而局灶节段性肾小球硬化是最常见的复发性GN（41%），发病非常早（中位时间为3个月）。复发性疾病患者的1年移植肾存活率优于新发患者，分别为76%和55%（p = 0.24）。与移植肾存活相关的最佳预测因素为：活检时蛋白尿<3.5 g[相对危险度（RR）= 0.24，p = 0.017]、血清肌酐低于2.0 mg/dL（RR = 0.06，p = 0.016）以及使用血管紧张素转换酶抑制剂（ACEI）（RR = 0.12，p = 0.005）。使用ACEI显著提高了1年移植肾存活率（92%对47%，p < 0.001）。
PTx - GN对肾移植存活有强烈的负面影响。新发GN的预后似乎比复发性GN更差。使用ACEI的患者在随访中存活率更高。
