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先天性肾脏和尿路异常(CAKUT)中的肾移植

Kidney Transplantation in Congenital Abnormalities of Kidney and Urinary Tract (CAKUT).

作者信息

Maringhini Silvio, Pape Lars

机构信息

Department of Pediatrics, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Via Ernesto Tricomi, 5, 90127 Palermo, Italy.

Department of Pediatrics II, University Hospital of Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany.

出版信息

Biomedicines. 2025 Apr 10;13(4):932. doi: 10.3390/biomedicines13040932.

Abstract

Congenital anomalies of the kidney and urinary tract (CAKUT) are a common cause of chronic kidney disease in children. Most patients will reach end-stage renal function and dialysis or transplantation in childhood or early adulthood. Patients with CAKUT deserve a careful evaluation before a kidney transplant; detailed imaging and functional studies are necessary, particularly in the presence of lower urinary tract abnormalities, and surgical procedures are advisable in selected cases. A higher incidence of complications has been reported after a kidney transplant in CAKUT, mainly urinary tract infections. However, in the long term, the prognosis seems to be comparable to other kidney diseases. A large number of reports are available in the literature on medical and surgical management of patients with CAKUT before, during, and after a kidney transplant; almost all recommendations of surgical procedures before a kidney transplantation are based on retrospective not controlled studies or personal opinions; prospective controlled studies are needed. In this narrative, nonsystematic review, we report the results of recently published selected studies and underline questions that should be addressed in future guidelines.

摘要

先天性肾脏和尿路畸形(CAKUT)是儿童慢性肾脏病的常见病因。大多数患者将在儿童期或成年早期发展至终末期肾功能并需要透析或移植。CAKUT患者在进行肾移植前值得仔细评估;详细的影像学和功能研究是必要的,尤其是存在下尿路异常的情况,并且在某些选定病例中建议进行手术治疗。据报道,CAKUT患者肾移植后并发症的发生率较高,主要是尿路感染。然而,从长期来看,其预后似乎与其他肾脏疾病相当。关于CAKUT患者在肾移植前、中和后的内科和外科治疗,文献中有大量报道;几乎所有肾移植前手术治疗的建议都是基于回顾性而非对照研究或个人观点;需要进行前瞻性对照研究。在本叙述性非系统性综述中,我们报告了最近发表的选定研究结果,并强调了未来指南中应解决的问题。

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本文引用的文献

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Chronic Kidney Disease Progression-A Challenge.慢性肾脏病进展——一项挑战
Biomedicines. 2024 Sep 27;12(10):2203. doi: 10.3390/biomedicines12102203.
4
Genetics of Chronic Kidney Disease.慢性肾脏病的遗传学
N Engl J Med. 2024 Aug 15;391(7):627-639. doi: 10.1056/NEJMra2308577.
5
Review - Renal transplantation for congenital urological diseases.综述-先天性泌尿道疾病的肾移植。
J Pediatr Urol. 2024 Oct;20(5):990-997. doi: 10.1016/j.jpurol.2024.07.017. Epub 2024 Jul 24.
6
Congenital anomalies of the kidney and urinary tract.肾脏和泌尿系统先天性异常。
Front Med (Lausanne). 2024 Jul 15;11:1384676. doi: 10.3389/fmed.2024.1384676. eCollection 2024.

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