活体捐肾者的医学风险分析

绝大多数的捐肾者在其整个生命周期里是安全的,但也面临一些医学风险。多项循证医学证据分析显示,捐肾后蛋白尿发生率为10%。捐肾可使微量白蛋白尿的发生风险增加3.9倍。捐肾后10年高血压发病率为9%～36%,需使用降压药的比例为9%～15%,收缩压较术前升高6mmHg(1mmHg=0.133kPa),舒张压较术前升高4mmHg。捐肾可使血压升高的风险增高1.9倍,但捐肾不增加心血管事件发生率。捐肾者终末期肾功能衰竭发生率0.04%,原因主要有高血压(35.71%)、局灶性肾小球硬化(16.07%)、慢性肾盂肾炎(12.50%)、糖尿病(3.57%)等。捐肾后6年时肾小球滤过率较术前下降了26mL·min-1·(1.73m2)-1,捐肾后12年时85.5%的捐肾者肾小球滤过率在60mL·min-1·(1.73m2)-1以上。因此,有必要提高医患双方对捐肾长期安全性的认识,加强监控,及时采取有针对性的肾脏保护性治疗措施。

Long-term safety evaluation of living kidney donors

Most of living kidney donors maintain good health,but some are confronted with some medical risks. It was indicated by some evidence-based studies that the postoperative incidence of proteinuria was 10% . A 3. 9-fold increase in the risk of microalbuminuria after donation was noted. The incidence of hypertension in 10 years after donation was 9%-36% ,of which 9%-15% required antihypertensive treatment; postoperative systolic and diastolic pressure was 6 mm Hg ( 1 mm Hg =0. 133 kPa) and 4 mm Hg higher than t...