慢性肾功衰2004（本科正式）课件_1.ppt

* 肾移植 ABO血型配型是主要的，要在HLA配型合适的基础上，选择供肾者。HLA配型佳者，肾移植效果较好。 移植肾可由尸体供肾或由亲属提供(由兄弟姐妹或父母供肾)。 肾移植后长期应用免疫抑制药物，以防排异反应，常用药物为激素、环孢素A和(或)硫唑嘌呤。 * 在应用环抱素后，移植肾的存活率有较大的提高，移植肾的1年存活率约为85％，5年存活率约为60％。HLA配型佳者，移植肾的存活时间较长。 接受肾移植患者，第1年死亡率约为5％。 肾移植后要使用大量免疫抑制剂，因而并发感染者增加，恶性肿瘤发病率也增加。 * * ACE inhibitors interfere with the pathophysiology of coronary ischaemia and renal insufficiency through blockade of the renin-angiotensin system (Willenheimer et al 1999). In adult tissues, virtually all known deleterious effects of angiotensin II (AII) ? the end product of the renin-angiotensin system ? are attributable to the AT1 receptor (Dahl?f 1995). The adverse cerebral and cardiovascular effects of AII, which have potentially lethal sequelae, are pervasive. Preclinical data implicate A II in cerebro-vascular ischaemia through the development of atherosclerosis (Daugherty et al 2000). By potentiating the activity of other neurohormonal systems, AII exerts harmful cardiovascular effects by means of the AT1 receptor (Willenheimer et al 1999) ? including vasoconstriction (Willenheimer et al 1999), vascular hypertrophy (Fyhrquist et al 1995), left ventricular hypertrophy (Fyhrquist et al 1995), myocardial and vascular wall fibrosis (Willenheimer et al 1999), myocardial remodeling (Fyhrquist et al 1995), and cardiac myocyte apoptosis under some conditions (Booz Baker 1998) ? and thereby contributes to the development of hypertension, heart failure, and myocardial infarction (Dahl?f 1995; Fyhrquist et al 1995). AII also plays a central role in the development of renal insufficiency in response to heart failure. As cardiac function deteriorates, decreased renal blood flow leads to a reduced glomerular filtration rate (Beers Berkow [eds.] 1999). Intense sympathetic activation in heart failure stimulates production of AII in the kidney (Beers Berkow [eds.] 1999) that initiates a cascade of potentially deleterious renal effects including proteinuria (Anderson