De Francisco A M, Mauer S M, Steffes M W, Goetz F C, Najarian J S, Sutherland D E
Department of Surgery, University of Minnesota Hospital, Minneapolis 55455.
J Diabet Complications. 1987 Oct-Dec;1(4):128-31. doi: 10.1016/s0891-6632(87)80070-3.
In order to assess the nephrotoxic effect of cyclosporine on native kidneys in pancreas transplant recipients, serum creatinine and creatinine clearance levels were determined before and serially after pancreas transplantation alone in 33 non-uremic Type I diabetic patients. The mean serum creatinine level before transplant was 1.0 +/- 0.3 mg/dl, and the values at 2 weeks, 6 months, 1 to 2 years, and greater than 2 years after transplant were, respectively, 1.5 +/- 0.6, 1.4 +/- 0.4, 1.4 +/- 0.5, and 1.5 +/- 0.2 mg/dl. Mean creatinine clearance level before transplant was 90 +/- 34 ml/min, and the values at the corresponding time points were 55 +/- 23, 62 +/- 22, 58 +/- 13, and 63 +/- 16. Thus, the mean changes in both parameters were approximately 50% in the immediate period after transplant, and there was no additional deterioration by these measures of renal function. The changes were somewhat greater than those reported in newly diagnosed diabetic patients receiving cyclosporine for immunotherapy, but all of the subjects had histologic evidence of diabetic nephropathy at the time of transplant. Although the stabilization of renal function is encouraging, damage to the kidneys may be silent and serial renal biopsies are needed to allow full assessment of the impact of cyclosporine on renal pathologic conditions.
为了评估环孢素对胰腺移植受者自身肾脏的肾毒性作用，对33例非尿毒症I型糖尿病患者在单纯胰腺移植前后分别测定了血清肌酐和肌酐清除率水平。移植前血清肌酐平均水平为1.0±0.3mg/dl，移植后2周、6个月、1至2年以及2年以上时的数值分别为1.5±0.6、1.4±0.4、1.4±0.5和1.5±0.2mg/dl。移植前肌酐清除率平均水平为90±34ml/min，相应时间点的数值分别为55±23、62±22、58±13和63±16。因此，移植后短期内这两个参数的平均变化约为50%，且这些肾功能指标未出现进一步恶化。这些变化比接受环孢素免疫治疗的新诊断糖尿病患者报告的变化略大，但所有受试者在移植时均有糖尿病肾病的组织学证据。尽管肾功能的稳定令人鼓舞，但肾脏损伤可能是隐匿性的，需要进行系列肾活检以全面评估环孢素对肾脏病理状况的影响。
