羥乙基淀粉對腎移植受體腎功能影響

1、老爸花老爸花10萬元從黑市買的一幅古畫，拿回家后全家人都哭了！萬元從黑市買的一幅古畫，拿回家后全家人都哭了！!羥乙基淀粉與滲透性腎病中山大學(xué)附屬第三醫(yī)院麻醉科滲透性腎病因靜脈滴注高滲溶液引起腎小管細(xì)胞腫脹、空泡樣變性稱為滲透性腎病 osmotic-nephrosis，臨床可表現(xiàn)為蛋白尿、血尿、腎功能損害，嚴(yán)重者發(fā)生急性腎衰竭. 一般認(rèn)為大劑量高滲液引起腎小管上皮細(xì)胞腫脹，空泡樣變致腎小管閉塞引起滲透性腎病，可能與腎小管-腎小球反饋機(jī)理以及高濃度高滲液引起腎血管痙攣有關(guān)。 Effect of hydroxyethylstarch in brain-dead kidney donors on re

2、nal function in kidney-transplant recipients M L Cittanova, I Leblanc, Ch Legendre, C Mouquet, B Riou, P Coriat THE LANCET ，Vol 348 December 14, 1996 Background Hydroxyethylstarch used as a plasma-volume expander in brain-dead kidney donors has been suggested to induce osmotic-nephrosis-like lesions

3、. Methods 52 patients who had received hydroxyethylstarch or iodinated contrast-media before brain death were excluded. 69 other brain-dead patients were prospectively included over 18 months and randomised into two groups. Among these 69, multiple organs were obtained in 29, including kidneys in 27

4、 cases. Multiple organ procurement was not possible in 40 patients because of relatives refusal (25), cardiac arrest (7), cancer (1), sepsis (2), viral hepatitis or HIV infection (3), and coroners refusal (2). We therefore studied 27 organ donors(hydroxyethylstarch-gelatin 15,gelatin-only 12) . In t

5、he hydroxyethylstarch-gelatin group, patients received hydroxyethylstarch up to 33 mL/kg for colloid plasma-volume expansion, and afterwards received modified fluid gelatin. In the gelatin-only group, patients received only modified fluid gelatin as colloid plasma-volume expander. All organ donors r

6、eceived fluid expansion according to transoesophageal echographic data. Hypovolaemia was diagnosed when left-ventricular end-diastolic area (LVEDa) was below 55 cm 2 /m 2 . Catecholamine doses were adjusted to obtain a mean arterial pressure between 60 and 100 mm Hg, after fluid loading if necessary

7、. Findings There were no significant differences in the characteristics of patients between the two groups of kidney donors or of recipients (except for a small imbalance in sex in the recipients) . No adverse reaction to either expander was observed. Also, there was no significant difference in ser

8、um creatinine level before organ procurement (meanSD) 84 38 mol/L in the hydroxyethylstarch group versus 89 29 mol/L in the gelatin-only group. During the first 8 days after transplantation, nine of 27 (33%) patients required extrarenal haemodialysis in the hydroxyethylstarch-gelatin group compared

9、with one of 20 (5%) in the gelatin-only group (p=0029) . Serum creatinine concentrations were significantly lower in the gelatin-only group than in the other group (p=0009) . 10 days after transplantation, mean (SD) serum creatinine was, respectively, 145 (70) and 312 (259) mol/L. Nine renal-biopsy

10、specimens were examined (six in the gelatin-only group). All three specimens in the hydroxyethylstarch-gelatin group had osmotic-nephrosis-like lesions in the tubules. In this prospective randomised study we found that administration of hydroxyethylstarch to brain-dead kidney donors worsened the pro

11、gnosis of renal transplantation. We saw a higher frequency of extrarenal haemodialysis during the first 8 days, and increased serum creatinine during the first 10 days. The renal biopsies in nine kidney recipients showed osmotic-nephrosis-like lesions only in the hydroxyethylstarch-gelatin group. Mo

12、stly proximal but also distal tubules were affected. These lesions were found in kidney-transplant biopsy specimens as long as 2 years after transplantation (data from ChL), which suggests a thesaurisoma mechanism. Interpretation These data suggest that hydroxyethylstarch used as a plasma-volume expander in brain-dead donors impairs immediate renal function in kidney-transplant recipients. 羥乙基淀粉致急性腎功能衰竭的病理特征羥乙基淀粉致急性腎功能衰竭的病理特征丁堯海 張愛平 王艷俠 涂曉文 張穎瑋中華腎臟病雜志2003 年 10月第 19卷第5 期 低 分 子 右 旋 糖 配 可 引 起 ARF,病理改變?yōu)闈B透性腎病。HES為合成高滲液體 ,是低分子右旋糖醉同類物質(zhì) ,提示同樣能引起滲透性腎病. 本組病理改變特