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目的探讨慢性移植肾肾病(CAN)的临床诊断及治疗特点。方法回顾性分析32例CAN临床资料。经移植肾穿刺活检诊断CAN32例。全部病例予减少环孢素A(CsA)剂量,浓度控制在(100±40)ng/ml上下,应用血管紧张素Ⅱ受体拮抗剂或血管紧张素转化酶抑制剂,限制蛋白质饮食,控制高血压。结果2个月后28例治疗有效,血肌酐恢复到(135±32)μmol/L(与术后比较,P>0·05,n=28),其中20例蛋白尿消失,移植肾活检复查证实CAN无进展恶化。无效4例,治疗前肌酐已达195~286μmol/L,移植肾活检复查显示CAN进展恶化。结论移植肾穿刺活检是诊断CAN的主要手段,血肌酐达到160~180μmol/L时予干预治疗预后较好。
Objective To investigate the clinical diagnosis and treatment of chronic allograft nephropathy (CAN). Methods Retrospective analysis of 32 cases of CAN clinical data. Transplantation of renal biopsy diagnosis of CAN32 cases. All cases were given cyclosporine A (CsA) at a dose of (100 ± 40) ng / ml, with angiotensin II receptor antagonist or angiotensin-converting enzyme inhibitor to limit protein diet and high control blood pressure. Results Two months later, 28 cases were treated effectively and the serum creatinine was restored to (135 ± 32) μmol / L (compared with postoperative, P> 0.05, n = 28) Confirmed that CAN no progress worsened. In 4 cases, the creatinine had reached 195 ~ 286μmol / L before treatment, and the renal transplant biopsy showed that the progress of CAN was worsened. Conclusion Transplant renal biopsy is the main method of diagnosis of CAN. When the serum creatinine reaches 160 ~ 180μmol / L, the prognosis of interventional therapy is better.