肾移植高血压患者药学监护培训.pptVIP

肾移植高血压患者药学监护 　　 胡永芳 Major Contents Cause of hypertension in the renal transplantation Treatment of hypertension in the renal transplant recipient Anti-hypertension medications Case Study Patient details ( renal transplantation) Number : 4438420 Sex: Male Weight: 63 kg High: 160 cm Date of Birth: 1943/02/09 Age: 63 years Disease: Chronic nephritis Operation date: 2006/04/19 Cadaveric Cold ischemia time (hours) : 12 Heat ischemia time (minutes) : 5 Current medication Immunosuppressive regiments Cyclosporine 100 mg Bid 125 mg Bid ALG 250 mg QD Mizoribine 100 mg QD, 50 mg QN Mycophenolate mofetil 750mg Bid Methylprednisolone 500mg Qd 3d Prednisolone 30mg Qd Current anti-hypertensive medications Metoprolol 12.5 mg Q12h Nifedipine Controlled released 30 mg qd 30 mg Q12h Enalapril 10 mg Q12h Furosemide 40mg tid 40mg qd Graft and patient survival Kaplan–Meier analyses with the populationdivided into quintiles of diastolic BP Summary of anti-hypertensives with patient and graft outcomes Diagnosis and treatment of hypertension in the renal transplant recipient Frequency of hypertension 60-85 % renal transplant recipients 90 % renal transplant recipients administrated CsA Cause of hypertension 免疫抑制剂的使用 移植肾相关的因素 急、慢性排斥反应 慢性移植肾病 肾动脉狭窄,复发性或新发性肾病,药物肾毒性,尿路梗阻 原肾高肾素潴留 红细胞增多症 Risk Factor 免疫抑制剂的升压 移植肾功能受损 移植肾动脉狭窄 RTRs 的平均动脉压每升高10mmHg ,其移植肾脏功能衰竭的发生率上升30 % 肾移植后合并血压升高者急性排斥反应发生率远远高于血压降低者 尸体肾移植较活体肾移植发生率高 Diagnosis hypert