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中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (02) : 107 -110. doi: 10.3877/cma.j.issn.2096-1537.2017.02.006

所属专题: 文献

临床研究

横纹肌溶解症合并急性肾功能衰竭供体的肾脏功能维护
袁小鹏1, 陈传宝1, 谢文峰2, 郑东华3, 周健1, 韩明1, 王小平1, 何晓顺1,()   
  1. 1. 510700 广州,中山大学附属第一医院东院器官移植科
    2. 510700 广州,中山大学附属第一医院重症医学科
  • 收稿日期:2017-04-24 出版日期:2017-05-28
  • 通信作者: 何晓顺
  • 基金资助:
    卫生部部属(管)医院临床学科重点项目(2010159); 广东省科技计划重点项目(2011A030400005)

Maintenance of kidney function in donors with rhabdomyolysis and acute renal failure

Xiaopeng Yuan1, Chuanbao Chen1, Wenfeng Xie2, Donghua Zheng3, Jian Zhou1, Ming Han1, Xiaoping Wang1, Xiaoshun He1,()   

  1. 1. Department of Organ Transplantation, Eastern Campus of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510700, China
    3. Department of Critical Care Medicine, Eastern Campus of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510700, China
  • Received:2017-04-24 Published:2017-05-28
  • Corresponding author: Xiaoshun He
  • About author:
    Corresponding author: He Xiaoshun, Email:
引用本文:

袁小鹏, 陈传宝, 谢文峰, 郑东华, 周健, 韩明, 王小平, 何晓顺. 横纹肌溶解症合并急性肾功能衰竭供体的肾脏功能维护[J/OL]. 中华重症医学电子杂志, 2017, 03(02): 107-110.

Xiaopeng Yuan, Chuanbao Chen, Wenfeng Xie, Donghua Zheng, Jian Zhou, Ming Han, Xiaoping Wang, Xiaoshun He. Maintenance of kidney function in donors with rhabdomyolysis and acute renal failure[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(02): 107-110.

目的

探讨横纹肌溶解症合并急性肾功能衰竭(ARF)供体的肾脏功能维护方法。

方法

回顾性分析中山大学附属第一医院东院2012年1月至2016年12月器官捐献供体中,因横纹肌溶解症导致供体ARF的器官功能维护和肾移植临床资料。常规维护包括血流动力学处理、纠正低氧血症、稳定内环境;针对横纹肌溶解症和急性肾损伤的特殊维护包括扩容治疗、碱化尿液、血浆置换和肾脏替代疗法(RRT)。

结果

15例供体因横纹肌溶解症导致ARF,供体血肌酸激酶峰值浓度为(15 569± 8597)U/L,血浆肌红蛋白峰值浓度为(37 092±42 100)μg/L,血清肌酐峰值浓度为(422±167)μmol/L。常规维护方法包括处理原发疾病、中度扩容和碱化尿液。其中3例接受血浆置换治疗,2例行RRT,1例接受体外膜肺氧合治疗。30例受体,肾移植术后6例发生移植肾功能延迟恢复。随访15~48个月,人肾均存活。肾移植术后12、24个月肾小球滤过率分别为(68.1±15.3)和(70.3±14.6)ml/(min?1.73m2)。

结论

横纹肌溶解症合并ARF供体,经适当维护后,供肾移植可获得良好功能。

Objective

To explore the methods of maintenance of kidney function in donors with rhabdomyolysis and acute renal failure (ARF).

Methods

Kidney donors with ARF caused by rhabdomyolysis and the methods of donor maintenance from January 2012 to December 2016 were retrospectively reviewed. The routine maintenance methods include hemodynamic treatment, correcting hypoxia and stabilizing the balance of fluids and electrolytes. The specific strategies of rhabdomyolysis and ARF include volume expansion, urinary alkalinization, plasmapheresis and renal replacement therapy (RRT).

Results

Fifteen donors suffered from rhabdomyolysis and ARF were enrolled in the present study. The peak level of creatinine kinase serum myoblobin and serum creatinine were (15 569±8597) U/L, (37 092±42 100) μg/L and (422±167) μmol/L, respectively. Three donors received plasmapheresis therapy (1-2 sessions), 2 donors received RRT and 1 donor received extra-corporeal membrane oxygenation treatment. Kidneys from these donors were transplanted into 30 recipients, among which delayed graft function was found in 6 patients. With a follow-up to 15-48 months, all patients and renal grafts survived. The mean of glomerular filtration rate were (68.1±15.3) and (70.3±14.6) ml/ (min?1.73 m2), respectively at 12 and 24 month after transplantation.

Conclusion

Kidneys donors with ARF and rhabdomyolysis had an excellent short-term outcome after appropriate maintenance.

1
Yuan XP, Han M, Wang XP, et al. Kidney transplantation from cardiac death donors with terminal acute renal failure[J]. Transplant Proc, 2014, 46(4): 1057-1060.
2
Bosch X, Poch E, Grau JM. Rhabdomyolysis and acute kidney injury[J]. N Engl J Med, 2009, 361(1): 62-72.
3
Chavez LO, Leon M, Einav S, et al. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice[J]. Crit Care, 2016, 20(1): 135.
4
Lappalainen H, Tiula E, Uotila L, et al. Elimination kinetics of myoglobin and creatine kinase in rhabdomyolysis: implications for follow-up[J]. Crit Care Med, 2002, 30(10): 2212-2215.
5
Oda J, Tanaka H, Yoshioka T, et al. Analysis of 372 patients with Crush syndrome caused by the Hanshin-Awaji earthquake[J]. J Trauma, 1997, 42(3): 470-475.
6
Veenstra J, Smit WM, Krediet RT, et al. Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis[J]. Nephrol Dial Transplant, 1994, 9(6): 637-641.
7
Zuckerman JM, Singh RP, Farney AC, et al. Single center experience transplanting kidneys from deceased donors with terminal acute renal failure[J]. Surgery, 2009, 146(4): 686-694.
8
Leyking S, Poppleton A, Sester U, et al. Kidney transplantation from a deceased donor with anuric acute kidney injury caused by rhabdomyolysis[J]. Transplantation, 2014, 98(10): e87-e88.
9
Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)[J]. Crit Care, 2013, 17(1): 204.
10
Dictus C, Vienenkoetter B, Esmaeilzadeh M, et al. Critical care management of potential organ donors: our current standard[J]. Clin Transplant, 2009, 23 Suppl 21: 2-9.
11
Mascia L, Mastromauro I, Viberti S, et al. Management to optimize organ procurement in brain dead donors[J]. Minerva Anestesiol, 2009, 75(3): 125-133.
12
Mi Z, Novitzky D, Collins JF, et al. The optimal hormonal replacement modality selection for multiple organ procurement from brain-dead organ donors[J]. Clin Epidemiol, 2015, 7: 17-27.
13
Novitzky D, Mi Z, Videla LA, et al. Hormone resuscitation therapy for brain-dead donors -- is insulin beneficial or detrimental?[J]. Clin Transplant, 2016, 30(7): 754-759.
14
Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate[J]. Ann Intern Med, 2009, 150(9): 604-612.
15
Holt SG, Moore KP. Pathogenesis and treatment of renal dysfunction in rhabdomyolysis[J]. Intensive Care Med, 2001, 27(5): 803-811.
16
Mekeel KL, Moss AA, Mulligan DC, et al. Deceased donor kidney transplantation from donors with acute renal failure due to rhabdomyolysis[J]. Am J Transplant, 2009, 9(7): 1666-1670.
17
Adrogue HJ, Madias NE. Hypernatremia[J]. N Engl J Med, 2000, 342(20): 1493-1499.
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