臨牀透析 Vol.27 No.4(2-9)


特集名 透析診療における分子バイオマーカーの新たな展開
題名 ［各論― 日常透析診療に役立つ分子バイオマーカー］膠原病・血管炎
発刊年月 2011年 04月
著者 湯村 和子 自治医科大学腎臓内科
著者 濱野 慶朋 自治医科大学腎臓内科
【 要旨 】 近年，高齢化社会になり，高齢者に好発する腎疾患からの透析導入患者が増えてきている．また，膠原病の腎障害のSLE腎炎からの透析患者の人数も減ることはない．透析導入後も，このような腎臓以外の多臓器障害を有する原疾患のコントロールが必要であり，バイオマーカーや臨床徴候をもとに，原疾患の再燃のキャッチを迅速に行い，治療を継続することが，生命維持には重要である．具体的には，急速進行性腎炎は，ANCA関連血管炎が多く，非特異的炎症徴候（発熱，体重減少，関節痛など），多臓器障害の出現増悪（肺病変など）やANCAの動向をみて，また，SLE腎炎でも，活動性の徴候（発熱，関節痛など）や血清補体価の動態で再燃をキャッチし，適切な治療を行わなければならない．
Theme New Perspectives of Molecular Biomarker in Dialysis Therapy
Title Biomarker of SLE nephritis and ANCA associated vasculitis
Author Wako Yumura Department of Nephrology, Jichi Medical University
Author Yoshitomo Hamano Department of Nephrology, Jichi Medical University
[ Summary ] In recent years, the number of patients initially receiving dialysis and those having kidney disease who are senior citizens, has gradually increased. The number of people receiving dialysis due to SLE nephritis does not seem to have decreased. Control of diseases related to SLE is required after dialysis introduction. Diseases leading to multiple organ failure as well as kidney dysfunction may be recognized by examining biomarkers and other clinical indications which are important in indicating the presence of recurring diseases quickly and providing life time maintenance therapy. ANCA associated vasculitis specifically indicates elevated ANCA in many recurrent cases. We must recognize recurrent disease conditions when delivering hemodialysis. Cases exhibiting active signs and changes in serum complement (CH50) titres must be treated appropriately.
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