羟乙基淀粉对肾移植受体肾功能影响优秀案例课件.ppt

1、羟乙基淀粉对肾移植受体肾功能影响（优选）羟乙基淀粉对肾移植受体肾功能影响渗透性肾病因静脉滴注高渗溶液引起肾小管细胞肿胀、空泡样变性称为渗透性肾病 osmotic-nephrosis，临床可表现为蛋白尿、血尿、肾功能损害，严重者发生急性肾衰竭.一般认为大剂量高渗液引起肾小管上皮细胞肿胀，空泡样变致肾小管闭塞引起渗透性肾病，可能与肾小管肾小球反馈机理以及高浓度高渗液引起肾血管痉挛有关。Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipients M L

2、 Cittanova,I Leblanc,Ch Legendre,C Mouquet,B Riou,P Coriat THE LANCET，Vol 348 December 14,1996 Background Hydroxyethylstarch used as a plasmavolume expander in braindead kidney donors has been suggested to induce osmoticnephrosislike lesions.Methods 52 patients who had received hydroxyethylstarch or

3、 iodinated contrastmedia before brain death were excluded.We saw a higher frequency of extrarenal haemodialysis during the first 8 days,and increased serum creatinine during the first 10 days.In the hydroxyethylstarchgelatin group,patients received hydroxyethylstarch up to 33 mL/kg for colloid plasm

4、avolume expansion,and afterwards received modified fluid gelatin.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).Also,there was no significant difference

5、in serum creatinine level before organ procurement (meanSD)84 38 mol/L in the hydroxyethylstarch group versus 89 29 mol/L in the gelatinonly group.Mostly proximal but also distal tubules were affected.Methods 52 patients who had received hydroxyethylstarch or iodinated contrastmedia before brain dea

6、th were excluded.69 other braindead patients were prospectively included over 18 months and randomised into two groups.Mostly proximal but also distal tubules were affected.Methods 52 patients who had received hydroxyethylstarch or iodinated contrastmedia before brain death were excluded.Effect of h

7、ydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipientsIn the hydroxyethylstarchgelatin group,patients received hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion,and afterwards received modified fluid gelatin.Multiple organ procurement was not

8、 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).Nine renalbiopsy specimens were examined (six in the gelatinonly group).Serum creatinine concentrations were significantly lower in the gela

9、tinonly group than in the other group(p=0009).羟乙基淀粉致急性肾功能衰竭的病理特征During the first 8 days after transplantation,nine of 27(33%)patients required extrarenal haemodialysis in the hydroxyethylstarchgelatin group compared with one of 20(5%)in the gelatinonly group(p=0029).All organ donors received fluid e

10、xpansion according to transoesophageal echographic data.THE LANCET，Vol 348 December 14,1996 69 other braindead 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 cases.Multiple organ procuremen

11、t 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(hydroxyethylstarchgelatin 15,gelatinonly 12).In the hydroxyethylstarchgelatin group,patients r

12、eceived hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion,and afterwards received modified fluid gelatin.In the gelatinonly group,patients received only modified fluid gelatin as colloid plasmavolume expander.All organ donors received fluid expansion according to transoesophageal

13、echographic data.Hypovolaemia was diagnosed when leftventricular enddiastolic 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.No adverse reaction to either expander was observed.Hypovolaem

14、ia was diagnosed when leftventricular enddiastolic area(LVEDa)was below 55 cm 2/m 2.During the first 8 days after transplantation,nine of 27(33%)patients required extrarenal haemodialysis in the hydroxyethylstarchgelatin group compared with one of 20(5%)in the gelatinonly group(p=0029).No adverse re

15、action to either expander was observed.M L Cittanova,I Leblanc,Ch Legendre,C Mouquet,B Riou,P Coriat（优选）羟乙基淀粉对肾移植受体肾功能影响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 corone

16、rs refusal(2).Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipients（优选）羟乙基淀粉对肾移植受体肾功能影响Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipientsAlso,there was no significant difference in serum creatini

17、ne level before organ procurement (meanSD)84 38 mol/L in the hydroxyethylstarch group versus 89 29 mol/L in the gelatinonly group.因静脉滴注高渗溶液引起肾小管细胞肿胀、M L Cittanova,I Leblanc,Ch Legendre,C Mouquet,B Riou,P CoriatEffect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytranspl

18、ant recipientsNo adverse reaction to either expander was observed.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).羟乙基淀粉对肾移植受体肾功能影响In the hydroxyethylstarc

19、hgelatin group,patients received hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion,and afterwards received modified fluid gelatin.Multiple organ procurement was not possible in 40 patients because of relatives refusal (25),cardiac arrest (7),cancer (1),sepsis (2),viral hepatitis o

20、r HIV infection(3),and coroners refusal(2).丁尧海 张爱平 王艳侠 涂晓文 张颖玮 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

21、observed.Also,there was no significant difference in serum creatinine level before organ procurement (meanSD)84 38 mol/L in the hydroxyethylstarch group versus 89 29 mol/L in the gelatinonly group.During the first 8 days after transplantation,nine of 27(33%)patients required extrarenal haemodialysis

22、 in the hydroxyethylstarchgelatin group compared with one of 20(5%)in the gelatinonly group(p=0029).Serum creatinine concentrations were significantly lower in the gelatinonly group than in the other group(p=0009).10 days after transplantation,mean(SD)serum creatinine was,respectively,145(70)and 312

23、(259)mol/L.Nine renalbiopsy specimens were examined (six in the gelatinonly group).All three specimens in the hydroxyethylstarchgelatin group had osmoticnephrosislike lesions in the tubules.In this prospective randomised study we found that administration of hydroxyethylstarch to braindead kidney do

24、nors worsened the prognosis 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 osmoticnephrosislike lesions only in the hydroxyethylstarchge

25、latin group.Mostly proximal but also distal tubules were affected.These lesions were found in kidneytransplant biopsy specimens as long as 2 years after transplantation(data from ChL),which suggests a thesaurisoma mechanism.We therefore studied 27 organ donors(hydroxyethylstarchgelatin 15,gelatinonl

26、y 12).Mostly proximal but also distal tubules were affected.Mostly proximal but also distal tubules were affected.Nine renalbiopsy specimens were examined (six in the gelatinonly group).We saw a higher frequency of extrarenal haemodialysis during the first 8 days,and increased serum creatinine durin

27、g the first 10 days.THE LANCET，Vol 348 December 14,1996The renal biopsies in nine kidney recipients showed osmoticnephrosislike lesions only in the hydroxyethylstarchgelatin group.Methods 52 patients who had received hydroxyethylstarch or iodinated contrastmedia before brain death were excluded.羟乙基淀

28、粉对肾移植受体肾功能影响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).（优选）羟乙基淀粉对肾移植受体肾功能影响Effect of hydroxyethylstarch in braindead kidney donors on renal function

29、in kidneytransplant recipientsIn the hydroxyethylstarchgelatin group,patients received hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion,and afterwards received modified fluid gelatin.（优选）羟乙基淀粉对肾移植受体肾功能影响Nine renalbiopsy specimens were examined (six in the gelatinonly group).Multi

30、ple 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).羟乙基淀粉对肾移植受体肾功能影响因静脉滴注高渗溶液引起肾小管细胞肿胀、The renal biopsies in nine kidney recipients showed osmoticnephrosislike les

31、ions only in the hydroxyethylstarchgelatin group.丁尧海 张爱平 王艳侠 涂晓文 张颖玮Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipients Interpretation These data suggest that hydroxyethylstarch used as a plasmavolume expander in braindead donors impairs immediate

32、 renal function in kidneytransplant recipients.M L Cittanova,I Leblanc,Ch Legendre,C Mouquet,B Riou,P Coriat因静脉滴注高渗溶液引起肾小管细胞肿胀、The renal biopsies in nine kidney recipients showed osmoticnephrosislike lesions only in the hydroxyethylstarchgelatin group.Findings There were no significant differences i

33、n 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.M L Cittanova,I Leblanc,Ch Legendre,C Mouquet,B Riou,P Coriat因静脉滴注高渗溶液引起肾小管细胞肿胀、因静脉滴注高渗溶液引起肾小管细胞肿胀、Als

34、o,there was no significant difference in serum creatinine level before organ procurement (meanSD)84 38 mol/L in the hydroxyethylstarch group versus 89 29 mol/L in the gelatinonly group.We therefore studied 27 organ donors(hydroxyethylstarchgelatin 15,gelatinonly 12).丁尧海 张爱平 王艳侠 涂晓文 张颖玮No adverse rea

35、ction to either expander was observed.Mostly proximal but also distal tubules were affected.These lesions were found in kidneytransplant biopsy specimens as long as 2 years after transplantation(data from ChL),which suggests a thesaurisoma mechanism.In the hydroxyethylstarchgelatin group,patients re

36、ceived hydroxyethylstarch up to 33 mL/kg for colloid plasmavolume expansion,and afterwards received modified fluid gelatin.In the gelatinonly group,patients received only modified fluid gelatin as colloid plasmavolume expander.No adverse reaction to either expander was observed.Effect of hydroxyethylstarch in braindead kidney donors on renal function in kidneytransplant recipients 羟乙基淀粉致急性肾功能衰竭的病理特征羟乙基淀粉致急性肾功能衰竭的病理特征丁尧海 张爱平 王艳侠 涂晓文 张颖玮中华肾脏病杂志2003 年 10月第 19卷第5 期