ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Diabetes mellitus is the leading cause of irreversible renal failure in the United States, Japan, and industrialized Europe. Of those diabetic patients begun on uremia therapy, 80% are treated with hemodialysis and 12% with peritoneal dialysis. Continuous ambulatory peritoneal dialysis is proposed by some as appropriate primary therapy for many diabetics with end-stage renal disease (ESRD), but peritonitis is common at one episode per 11 to 21 patient-months. Cardiovascular disease is accelerated in patients with diabetic ESRD and is the most common cause of death in diabetic dialysis patients. Although survival of diabetic ESRD patients is lower than that of nondiabetic patients (1- and 5-year patient survival is 74% and 19%, respectively, in diabetics and 78% and 40%, respectively, in all ESRD patients), morbidity and mortality figures have improved steadily over the past two decades. When possible, renal transplantation is advised as the treatment most likely to effect rehabilitation and long survival.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Atherosclerotic cardiovascular disease is a significant cause of morbidity and mortality in patients with chronic renal failure. It is unclear, however, if atherosclerosis in fact occurs at a higher incidence compared with the nonuremic population matched for age, hypertension, and diabetes mellitus or if it occurs at an accelerated rate following the onset of end-stage renal disease. The extent of true atherosclerotic lesions, versus clinically diagnosed “atherosclerosis,” in patients with chronic renal failure is equally unclear. Potentially, the uremic state per se, the dialysis treatment, and factors unrelated to renal failure may participate in atherogenesis. The relative contribution of each of these factors is unknown. In this review, we discuss the pathology of “atherosclerotic” lesions in patients with chronic renal failure and the putative factors involved in atherogenesis in this population and describe the results of available studies examining the issue of accelerated atherosclerosis in uremia.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Patients with end-stage renal disease present with an immunodeficient state paradoxically coexisting with signs of activation of immune system cells and that is accentuated rather than corrected by replacement dialysis therapy. The mechanisms of this immune system dysregulation presently under consideration are a reduced bioavailability of interleukin-2 secondary to its overconsumption by activated T cells; a downregulation of phagocyte adhesion molecules and opsonin receptors following their overexpression during dialysis with complement-activating membranes; an increased production of the cytokines interleukin-1, tumor necrosis factor-α, and interleukin-6 by activated monocytes and of soluble CD23 by B lymphocytes; and last, but far from least, the presence of uremic toxins. Perspectives of research are aimed at elucidating the respective role of the T helper cell subpopulations (Th-1 and Th-2) and the influence of the progression of chronic renal failure on the naturally occurring cytokine inhibitors, with the hope of better defining the rationale of strategies of immunomodulation that could be beneficial to patients with end-stage renal disease.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

HLA antigens are the major barrier to successful transplantation. Three of the seven heterodimers (HLA-A, -B, and -DR) contribute most to the immunogenicity of a mismatched organ. Although classical serology has been used in the past to phenotype donors and recipients, histocompatibility laboratories are increasingly turning to DNA-based methods to directly genotype patients and donors for the alleles of the HLA complex. Some methods are still evolving, while several others are established well enough to use in the clinical laboratory. The application to solid organ transplantation will result in greater accuracy and a better correlation between HLA matching and graft survival in the future. In fields such as bone marrow transplantation, where matching is critically important for prevention of graft-versus-host disease and engraftment, molecular HLA testing is already being mandated by the transplantation community.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Understanding the nature of allorecognition is fundamental to the design of antigen-specific therapies for transplantation. As recently as 10 years ago it was generally believed that recognition of major histocompatibility complex (MHC) molecules by T lymphocytes was direct and represented the “simplest” kind of T-lymphocyte interaction. It is now clear that the nature of allorecognition is complex, involving a variety of different forms of MHC antigens with or without peptides contained in their antigen-binding groove. In addition, there is renewed interest in alternative forms of allorecognition, including so-calledindirect allorecognition, in which donor alloantigens are recognized as peptides in the context of recipient self. Lastly, it appears that cells other than T lymphocytes, eg, natural killer cells, are capable of antigen-specific recognition and may be responsible for heretofore underappreciated mechanisms of transplant rejection.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

In the past year there has been considerable progress in defining the morphologic characteristics of the normally functioning renal allograft in the cyclosporine era. Based on these characteristics and knowledge of clinically validated important changes in rejection, internationally agreed upon standardized terms and criteria have been developed for the histologic diagnosis of acute and chronic rejection and allied conditions. Chronic changes observed in normally functioning grafts at 2 years posttransplantation have been shown to predict the presence of renal functional impairment for 4 years. Important new rejection changes have been identified in the peritubular capillaries. Various alternatives to core biopsy have been explored, but no technique as yet has sufficient sensitivity and specificity for general use in rejection diagnosis. The accurate distinction of chronic rejection from other conditions remains a challenge for the future.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

摘要:

Posttransplantation liver disease due to non-A, non-B hepatitis (NANBH) is an important cause of morbidity and mortality in renal transplant recipients. The cloning of the hepatitis C virus (HCV), which is the major cause of parenterally transmitted NANBH, and the development of tests to detect HCV infection have shed light on the prevalence, transmission, and natural course of HCV infection. This review discusses the influence of this information on transplantation policies.

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID

ISSN:1062-4821    

出版商:OVID    

年代:1993

数据来源: OVID