Proximal tubular dysfunction as an indicator of chronic graft dysfunction

被引:11
作者
Camara, N. O. S. [1 ,2 ]
Williams, W. W., Jr. [3 ,4 ]
Pacheco-Silva, A. [1 ]
机构
[1] Univ Fed Sao Paulo, Escola Paulista Med, Disciplina Nefrol, Hosp Rim & Hipertensao,Lab Imunol Clin & Expt, BR-04023900 Sao Paulo, Brazil
[2] Univ Sao Paulo, Inst Ciencias Biomed 4, Dept Imunol, Lab Imunobiol Transplantes, Sao Paulo, Brazil
[3] Harvard Univ, Massachusetts Gen Hosp, Boston, MA 02115 USA
[4] Hosp Albert Einstein, Inst Israelita Ensino Pesquisa, Unidade Transplante Renal, Sao Paulo, Brazil
基金
巴西圣保罗研究基金会;
关键词
Renal transplantation; Tubular proteins; Proximal tubular dysfunction; Chronic allograft nephropathy; Retinol binding protein; KIDNEY INJURY MOLECULE-1; EPITHELIAL-MESENCHYMAL TRANSITION; CHRONIC ALLOGRAFT NEPHROPATHY; RETINOL-BINDING-PROTEIN; TISSUE GROWTH-FACTOR; RENAL FIBROSIS; EXPRESSION; CYCLOSPORINE; REJECTION; CELLS;
D O I
10.1590/S0100-879X2009000300003
中图分类号
Q [生物科学];
学科分类号
07 ; 0710 ; 09 ;
摘要
New strategies are being devised to limit the impact of renal sclerosis on graft function. Individualization of immunosuppression, specifically the interruption of calcineurin-inhibitors has been tried in order to promote better graft survival once chronic graft dysfunction has been established. However, the long-term impact of these approaches is still not totally clear. Nevertheless, patients at higher risk for tubular atrophy and interstitial fibrosis (TA/IF) development should be carefully monitored for tubular function as well as glomerular performance. Since tubular-interstitial impairment is an early event in TA/IF pathogenesis and associated with graft function, it seems reasonable that strategies directed at assessing tubular structural integrity and function would yield important functional and prognostic data. The measurement of small proteins in urine such as alpha-1-microglobulin, N-acetyl-beta-D-glucosaminidase, alpha/pi S-glutathione transferases, beta-2 microglobulin, and retinol binding protein is associated with proximal tubular cell dysfunction. Therefore, its straightforward assessment could provide a powerful tool in patient monitoring and ongoing clinical assessment of graft function, ultimately helping to facilitate longer patient and graft survival associated with good graft function.
引用
收藏
页码:229 / 236
页数:8
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