Fernández Fresnedo Gema, Sánchez Plumed Jaime, Arias Manuel, Del Castillo Caba Domingo, López Oliva María Ovidia
Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander.
Nefrologia. 2009;29 Suppl 1:16-24. doi: 10.3265/NEFROLOGIA.2009.29.S.1.5633.EN.FULL.
Non-immunological factors in the progression of kidney disease in transplant patients are the following: high blood pressure, proteinuria, dislypidemia, etc. 1. Arterial hypertension treatment: Blood pressure must be measured periodically in all transplant patients. Similarly to native kidneys, in renal transplant patients arterial hypertension is a risk factor in the progression of kidney disease. Arterial hypertension represent a clinical marker of chronic allograft nephropathy and contributes to graft loss and to the morbid- mortality of these patients (Evidence level C). Blood pressure control should be < 130/80 mm Hg for renal transplant patients without proteinuria and 125/75 mm Hg for proteinuric patients (> 1 g/24 hours). Hypertension and proteinuria are frequently associated in the same patients, a global treatment of both seems more rational (Evidence level C). General measures should be instigated first with pharmacological therapy. All antihypertensive drugs are useful in renal transplant patients and the majority of patients will need two or more drugs. In proteinuric patients an angiotensin receptor antagonist or an ACE-inhibitor should be initiated. It is advisable to monitor the serum potassium and creatinine after the start of this drugs or during the treatment periodically, especially in patients with chronic kidney disease stage IV-V. 2. Proteinuria treatment: Proteinuria has been strongly correlated with reduced function and graft survival. Lowering proteinuria to values as near to normal as possible (< 0.5 g/24 hours). To reduce proteinuria, an angiotensin receptor antagonist, an ACE-inhibitor or a combination of both are required, with serum potassium or creatinine monitoring, especially in patients with chronic kidney disease stage IV-V. 3. Dyslipidemia treatment: For kidney transplant recipients the assessment of dyslipidemias should include a complete fasting lipid profile with total cholesterol, LDL, HDL, and triglycerides. Evidence from the general population indicates that treatment of dyslipidemias reduces cardiovascular disease and evidence in kidney transplant patients suggests that judicious treatment can be safe and effective in improving dyslipidemia. Therapeutic goal must be LDL < 100 mg/dl. (Evidence level C). 4. Others: Cigarette smoking, glucose intolerance or diabetes control and obesity should be assessed.
高血压、蛋白尿、血脂异常等。1. 动脉高血压的治疗：所有移植患者都必须定期测量血压。与天然肾脏一样，在肾移植患者中，动脉高血压是肾病进展的危险因素。动脉高血压是慢性移植肾肾病的临床标志物，会导致移植肾丢失以及这些患者的发病死亡率（证据等级C）。对于无蛋白尿的肾移植患者，血压控制应<130/80 mmHg，对于蛋白尿患者（>1 g/24小时），血压控制应<125/75 mmHg。高血压和蛋白尿在同一患者中常同时出现，对两者进行整体治疗似乎更合理（证据等级C）。首先应采取一般措施，然后进行药物治疗。所有抗高血压药物对肾移植患者都有用，大多数患者需要两种或更多种药物。对于蛋白尿患者，应开始使用血管紧张素受体拮抗剂或ACE抑制剂。在开始使用这些药物后或治疗期间，定期监测血清钾和肌酐是可取的，尤其是在慢性肾脏病IV-V期患者中。2. 蛋白尿的治疗：蛋白尿与肾功能降低和移植肾存活密切相关。将蛋白尿降至尽可能接近正常的值（<0.5 g/24小时）。为了降低蛋白尿，需要使用血管紧张素受体拮抗剂、ACE抑制剂或两者联合使用，并监测血清钾或肌酐，尤其是在慢性肾脏病IV-V期患者中。3. 血脂异常的治疗：对于肾移植受者，血脂异常的评估应包括完整的空腹血脂谱，包括总胆固醇、低密度脂蛋白、高密度脂蛋白和甘油三酯。来自普通人群的证据表明，血脂异常的治疗可降低心血管疾病风险，肾移植患者的证据表明，明智的治疗在改善血脂异常方面可以是安全有效的。治疗目标必须是低密度脂蛋白<100 mg/dl（证据等级C）。4. 其他：应评估吸烟、糖耐量异常或糖尿病控制情况以及肥胖情况。
