Pérez-Flores Isabel, Sánchez-Fructuoso Ana, Marcén Roberto, Fernández Ana, Fernández Lucas Milagros, Teruel José Luis
Servicio de Nefrología, Hospital Clínico San Carlos, Madrid.
Nefrologia. 2009;29 Suppl 1:54-61. doi: 10.3265/NEFROLOGIA.2009.29.S.1.5639.EN.FULL.
The early diagnosis of the graft intolerance syndrome or a subclinical state of chronic inflammation due to a failed kidney allograft, is one of the goals that the nephrologists must fulfill to take a series of measures directed to solve this situation. Fever, haematuria, local pain and/or tenderness are the main clinical criteria to make a diagnosis. However, oftenly there are not any clinical symptoms and only the presence of parameters of chronic inflammation (elevated C-reactive protein, erythrocyte sedimentation rate, hypoalbuminemia and anemia resistant to erythropoietin therapy) are signs of this entity. Maintenance of immunosuppressive treatment is not advisable due to the risk of infections as well as the increase in cardiovascular risk (level evidence A). Transplantectomy is the best treatment if there are some associated complications such as allograft infection, neoplasia or high risk of graft rupture. However, surgical treatment is not exempt from risks and it is associated to a considerable rate of complications, with the consequent prolongation of the hospitalization stay. Therefore it is desirable to use less invasive procedures, such as embolization. This could be the first step unless the conditions enumerated in point 3 come up (Level evidence B). It is desirable to use prophylactic antibiotic before the embolization to avoid infectious complications (Level evidence B).
肾移植耐受不良综合征或因肾移植失败导致的慢性炎症亚临床状态的早期诊断，是肾脏病学家为采取一系列措施解决这一情况而必须实现的目标之一。发热、血尿、局部疼痛和/或压痛是做出诊断的主要临床标准。然而，通常没有任何临床症状，只有慢性炎症参数（C反应蛋白升高、红细胞沉降率、低白蛋白血症和对促红细胞生成素治疗耐药的贫血）的存在才是该病症的体征。由于存在感染风险以及心血管风险增加（证据等级A），不建议维持免疫抑制治疗。如果存在一些相关并发症，如移植肾感染、肿瘤或移植肾破裂的高风险，移植肾切除术是最佳治疗方法。然而，手术治疗并非没有风险，且与相当高的并发症发生率相关，从而导致住院时间延长。因此，希望采用侵入性较小的程序，如栓塞术。除非出现第3点列举的情况（证据等级B），这可能是第一步。希望在栓塞术前使用预防性抗生素以避免感染并发症（证据等级B）。
