臨牀透析 Vol.30 No.9(7)


特集名 原疾患と合併症に合わせた透析導入と透析維持
題名 SLE,関節リウマチ
発刊年月 2014年 08月
著者 黒田 毅 新潟大学大学院医歯学総合研究科腎・膠原病内科学分野
【 要旨 】 全身性エリテマトーデスでは治療抵抗性の症例や再発例の一部で維持透析に導入される症例もしばしば経験されるが,多くの場合疾患活動性は残っており,ステロイドや免疫抑制薬などの治療の継続が必要である.合併する抗リン脂質抗体症候群,薬剤による易感染性やステロイドの長期の副作用に注意する必要がある.関節リウマチでは,血液透析導入時でも多くの場合疾患活動性があり,治療を継続する必要がある.二次性アミロイドーシスでは,透析導入時のトラブルを回避するための工夫が必要である.シャントは,病態の進行により変形がさらに進行する場合も多いため,将来の穿刺を考慮した作製も必要である.
Theme The initiation and maintenance of dialysis in terms of original kidney diseases and complications
Title Hemodialysis of patients with systemic lupus erythematosus and rheumatoid arthritis
Author Takeshi Kuroda Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
[ Summary ] Systemic lupus erythematosus patients often have relapses or experience refractory disease following treatment. Consequently, to manage diseases some of these patients must receive hemodialysis therapy. In most cases, patients must be treated with steroid and/or immunosuppressive therapy because their disease activity is still high. It is imperative to monitor these patients for anti-phospholipid syndrome, increased susceptibility to infection, and adverse effects of prolonged use of steroids. In contrast, the vast majority of rheumatoid arthritis patients need to be treated for rheumatoid arthritis. This is so for maintenance dialysis patients also. This is because the risk of active arthritis remains markedly high. Our study demonstrated that patients with amyloidosis had a higher mortality rates. Programmed initiation of hemodyalysis would improve the prognosis for patients with end stage renal disease. Additionally, in cases where surgical arteriovenous shunts are fashioned, it is necessary to pay attention to estimates on future progression of joint deformities.
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