| 特集名 | 透析医療におけるウーマン・ヘルス | |
|---|---|---|
| 題名 | 全身性エリテマトーデス（SLE）患者の透析 | |
| 発刊年月 | 2003年 07月 | |
| 著者 | 湯村 和子 | 東京女子医科大学第四内科 |
| 著者 | 内田 啓子 | 東京女子医科大学第四内科 |
| 著者 | 菅沼 信也 | 東京女子医科大学第四内科 |
| 著者 | 森山 能仁 | 東京女子医科大学第四内科 |
| 著者 | 内藤 順代 | 東京女子医科大学第四内科 |
| 著者 | 小池 美菜子 | 東京女子医科大学第四内科 |
| 著者 | 武井 卓 | 東京女子医科大学第四内科 |
| 著者 | 新田 孝作 | 東京女子医科大学第四内科 |
| 著者 | 二瓶 宏 | 東京女子医科大学第四内科 |
| 【 要旨 】 | 全身性エリテマトーデス（SLE）は女性に好発する膠原病である．SLEの腎障害（ループス腎炎）から腎不全となり，透析導入に至る患者は年間約300人で，新規導入の1％程度である．一般的には，SLEは透析導入時には“burn out”の状態であるといわれていたが，導入後もSLEとしての再燃が多いことがわかってきた．原発性腎疾患から透析導入する患者に比較し，SLE患者では導入時および導入後もその対応が異なる．感染症やブラッドアクセスのトラブルが多いこと，導入後もSLEの疾患活動性を認め治療を要することなど，これらの相違点を熟知し，透析を行っているSLE患者に対しての適切な治療・対応が求められる． | |
| Theme | Characteristic Problems in Managing Female Dialysis Patients | |
|---|---|---|
| Title | Hemodialysis in systemic lupus erythematosus patients | |
| Author | Wako Yumura | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| Author | Keiko Uchida | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| Author | Shinya Suganuma | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| Author | Takahito Moriyama | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| Author | Masayo Naito | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| Author | Minako Koike | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| Author | Takashi Takei | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| Author | Kousaku Nitta | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| Author | Hiroshi Nihei | Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| [ Summary ] | Systemic lupus erythematosus (SLE) is a collagen disease, which occurs more often in women. Renal failure resulting from lupus nephritis leads to approximately 300 patients requiring hemodialysis every year, accounting for roughly 1% all of new patients who begin hemodialysis. SLE had generally been thought to be eliminated at the beginning of hemodialysis, but it has recently been shown to recur often during treatment. SLE patients need different kinds of care at the start of and during hemodialysis treatment, compared to those who start it owing to primary renal diseases, such as chronic nephritis. At the start of hemodialysis, infectious complications and blood access troubles commonly occur. During hemodialysis, evidence of active SLE (immunological abnormalities, fever, arthralgia, alopecia, erythema, etc.) is often noted. Physicians are required to be familiar with these facts and give appropriate treatment and care to SLE patients receiving hemodialysis. In these patients, it is most important to effectively use immunosuppressive agents (mainly steroids) for SLE, and anticoagulation or antiplatelet therapy in order to maintain adequate blood flow. In the long-term, close attention should be paid to cardiovascular complications and infection as in other hemodialysis patients. |
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