促肾上腺皮质激素在肾移植后局灶节段性肾小球硬化治疗中的应用
Adrenocorticotropic Hormone in the Treatment of Focal Segmental Glomerulosclerosis Following Kidney Transplantation.
作者信息
Grafals Mónica, Sharfuddin Asif
机构信息
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
出版信息
Transplant Proc. 2019 Jul-Aug;51(6):1831-1837. doi: 10.1016/j.transproceed.2019.04.052.
This retrospective study examined the effect of adrenocorticotropic hormone therapy on remission of recurrent focal segmental glomerulosclerosis (FSGS) in patients with history of kidney transplant (KT) treated at 2 transplant centers. Patients with biopsy-confirmed FSGS following KT who received Acthar Gel (Mallinckrodt ARD, Bedminster, New Jersey, United States) treatment for ≥1 month were eligible. A total of 14 patients with idiopathic FSGS were included. Acthar Gel treatment resulted in complete remission of FSGS in 3 patients and partial remission in 2 patients for a total treatment response rate of 36% (5/14) of patients. Among patients showing complete or partial remission, Acthar Gel treatment duration ranged from 6 months to 2 years and 60% (3/5 patients) had serum creatinine ≤ 2 mg/dL at the start of Acthar Gel treatment. Patient outcomes suggest Acthar Gel may be an effective and tolerable treatment for recurrent FSGS in patients with history of KT. Early initiation of Acthar Gel treatment and therapy duration of at least 6 months may be needed for optimal response to Acthar Gel in patients with history of KT and recurrent FSGS.
这项回顾性研究调查了促肾上腺皮质激素疗法对在2个移植中心接受治疗的有肾移植（KT）病史的复发性局灶节段性肾小球硬化症（FSGS）患者缓解情况的影响。肾移植后经活检确诊为FSGS且接受Acthar Gel（美国新泽西州贝德明斯特的马林克罗特ARD公司生产）治疗≥1个月的患者符合条件。共纳入14例特发性FSGS患者。Acthar Gel治疗使3例患者的FSGS完全缓解，2例患者部分缓解，患者总治疗缓解率为36%（5/14）。在显示完全或部分缓解的患者中，Acthar Gel治疗持续时间为6个月至2年，60%（3/5例患者）在开始Acthar Gel治疗时血清肌酐≤2mg/dL。患者的治疗结果表明，Acthar Gel可能是治疗有KT病史的复发性FSGS患者的一种有效且耐受性良好的疗法。对于有KT病史和复发性FSGS的患者，可能需要尽早开始Acthar Gel治疗且治疗持续时间至少为6个月，以使Acthar Gel获得最佳疗效。
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