Merrill J P
Annu Rev Med. 1978;29:343-58. doi: 10.1146/annurev.me.29.020178.002015.
Both dialysis and kidney transplantation are effective techniques for prolonging life in ESRD. Because dialysis therapy does not effect replacement of the metabolic functions of the kidney, it is less tha perfect. Successful transplantation that replaces all of the aspects of renal function is the treatment of choice. Successful transplantation is highly dependent upon the availability of a suitable donor and the appropriate tissue match, which remains a problem. Present immunosuppressive therapy required to prevent the immunoresponse causing rejection of the renal allograft is a tool too dull for the job. Since all immunoresponse is suppressed, infections are common, as are the multiple complications of cortical steroid therapy. For the dialysis patient, development of more compact effective dialysis apparatus and particularly the availability of replacement therapy hold promise. New approaches to diminishing the immune response to the graft without impairing that to microorganisms may well effect improvement in graft survival as will increasing knowledge of factors other than HLA antigens in the immunologic reaction. Development of an effective method for arresting the progress of glomerulonephritis before it reaches end-stage renal failure would obviate the necessity for dialysis or transplant therapy in appoximately two thirds of ESRD patients.
透析和肾移植都是延长终末期肾病（ESRD）患者生命的有效技术。由于透析疗法无法实现肾脏代谢功能的替代，所以并非尽善尽美。能够替代肾脏所有功能的成功移植才是首选治疗方法。成功移植高度依赖于合适供体的可获得性以及适当的组织配型，而这仍然是个问题。目前用于防止免疫反应导致肾移植排斥的免疫抑制疗法对于这项任务而言过于无力。由于所有免疫反应都受到抑制，感染很常见，皮质类固醇疗法的多种并发症也很常见。对于透析患者来说，开发更紧凑有效的透析设备，尤其是提供替代疗法，有望带来改善。在不损害对微生物免疫反应的情况下，减少对移植物免疫反应的新方法很可能会提高移植物的存活率，就像增加对免疫反应中除HLA抗原之外其他因素的了解一样。开发一种在肾小球肾炎发展到终末期肾衰竭之前阻止其进展的有效方法，将使大约三分之二的ESRD患者无需进行透析或移植治疗。
