| Theme | Up-to-date renal replacement therapy for diabetic nephropathy -- Standardization and personalization | |
|---|---|---|
| Title | Kidney transplantation | |
| Publish Date | 2014/01 | |
| Author | Masahiro Ikeda | Division of Urology, Department of Regenerative & Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University |
| Author | Kazuhide Saito | Division of Urology, Department of Regenerative & Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University |
| Author | Yuki Nakagawa | Division of Urology, Department of Regenerative & Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University |
| Author | Masayuki Tasaki | Division of Urology, Department of Regenerative & Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University |
| Author | Kota Takahashi | Division of Urology, Department of Regenerative & Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University |
| [ Summary ] | Mortality rates for diabetic nephropathy (DMN) patients remain higher than those for other end stage kidney disease (ESKD) patients. This is because of these patients' high incidence of cardiovascular diseases (CVD). On the other hand, kidney transplantation (KT) has become established as the preferred alternative to renal replacement therapy (RRT) for ESKD. Transplantation has contributed to improved outcomes for ESKD patients including those with DMN. In the past decade, patient graft survival rates have dramatically improved due to developments in and adoption of new immunosuppressants and perioperative management techniques. Pre-emptive kidney transplantation (PEKT) has come to be considered a better choice than RRT because of the excellent outcomes attained. In general, regardless of the type of original renal disease, all ESKD patients receiving CKD and deemed to be stage 3 or higher, must be thoroughly screened and assessed for CVD despite of their symptoms. For DMN patients, sophisticated postoperative medical management is also important because surgical stress and some immunosuppressants tend to worsen glucose tolerance and insulin resistance. Long term, recurrence of DMN in transplanted kidneys reduces graft function and survival rates. Continuity of DM control after transplantation is also required. |
|