Mojcik C F, Klippel J H
National institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
Am J Med. 1996 Jul;101(1):100-7. doi: 10.1016/s0002-9343(96)00074-5.
To provide an overview of the course of systemic lupus erythematosus (SLE) following the onset of end-stage lupus nephropathy, regarding clinical and serological manifestations, survival on dialysis, and renal transplant outcomes.
A review of the pertinent literature, identified by a comprehensive Grateful Med search, was performed.
There is a tendency for decreased clinical and serological lupus activity following the onset of end-stage renal disease. The pathophysiology of this quiescence remains unclear. Survival of lupus patients on dialysis is no different from that of non-SLE dialysis patients, and is better than that of several other rheumatic diseases. Following renal transplantation, there is no difference in patient or graft survival in lupus versus nonlupus patients. Like their nonlupus counterparts, SLE transplant patients do better with living relative grafts and/or regimens containing cyclosporin A. Transplantation is not recommended within 3 months of the initiation of dialysis to allow possible recovery from the acute renal failure. Transplantation during an acute exacerbation of SLE is controversial, and may increase the risk of poor outcomes. Recurrence of lupus in transplanted allografts, often with the same histopathology as in the native kidney, occurs at a rate (2.7% to 3.8%) comparable to that for all allograft transplant failures (2% to 4%).
End-stage lupus nephropathy patients require less medication owing to decreased disease activity. They are good candidates for dialysis and renal transplantation, with survival and recurrence rates no different from those of other patients with end-stage renal disease.
就临床和血清学表现、透析生存率及肾移植结局，概述终末期狼疮性肾炎发病后的系统性红斑狼疮（SLE）病程。
通过全面的Grateful Med检索确定相关文献并进行综述。
终末期肾病发病后，临床和血清学狼疮活动度有下降趋势。这种静止状态的病理生理学仍不清楚。狼疮患者透析生存率与非SLE透析患者无异，且优于其他几种风湿性疾病。肾移植后，狼疮患者与非狼疮患者的患者生存率和移植物生存率无差异。与非狼疮患者一样，SLE移植患者接受亲属活体供肾移植和/或含环孢素A的方案效果更好。不建议在开始透析后3个月内进行移植，以便急性肾衰竭可能恢复。在SLE急性加重期进行移植存在争议，可能会增加不良结局的风险。移植同种异体肾中狼疮复发，其组织病理学常与原肾相同，复发率（2.7%至3.8%）与所有同种异体移植失败率（2%至4%）相当。
由于疾病活动度降低，终末期狼疮性肾炎患者所需药物较少。他们是透析和肾移植的合适人选，其生存率和复发率与其他终末期肾病患者无异。
