| 特集名 | 糖尿病性腎症への進歩した腎代替療法―その標準化と個別化 | |
|---|---|---|
| 題名 | 腎移植 | |
| 発刊年月 | 2014年 01月 | |
| 著者 | 池田 正博 | 新潟大学大学院医歯学総合研究科腎泌尿器病態学分野 |
| 著者 | 齋藤 和英 | 新潟大学大学院医歯学総合研究科腎泌尿器病態学分野 |
| 著者 | 中川 由紀 | 新潟大学大学院医歯学総合研究科腎泌尿器病態学分野 |
| 著者 | 田﨑 正行 | 新潟大学大学院医歯学総合研究科腎泌尿器病態学分野 |
| 著者 | 高橋 公太 | 新潟大学大学院医歯学総合研究科腎泌尿器病態学分野 |
| 【 要旨 】 | 腎移植は免疫抑制薬の進歩などにより成績が向上しており，優れた腎代替療法として有用性が確立している．糖尿病性腎症（DM腎症）の慢性腎不全患者は，心血管疾患（CVD）による死亡リスクが高く，透析導入後の予後は非常に悪い．一方，腎移植では透析に比べて生命予後の改善が望める．さらに透析による合併症を避けて腎移植を行うことが，移植腎生着率・生存率の上昇につながる．DM腎症患者ではとくにCVDを含む合併症の評価が重要であり，術前に十分な精査を行う．術後は手術侵襲，免疫抑制薬などにより糖尿病が悪化することが多く，厳密な血糖コントロールが必要となる．またDM腎症の再発が腎生着率を低下させるため，移植後も長期にわたり糖尿病の治療が必要である． | |
| Theme | Up-to-date renal replacement therapy for diabetic nephropathy -- Standardization and personalization | |
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| Title | Kidney transplantation | |
| 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. |
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