Renal Vein Thrombosis: An Uncommon Cause of Graft Failure

腎靜脈栓塞：一個少見的移植腎失敗原因

鍾民道(Min-Tao Chung) ； 周銘源(Min-Yen Chou) ； 高銘聰(Min-Tsung Kao) ； 林智一(Tze-Yi Lin)

《Mid-Taiwan Journal of Medicine》 9卷3期 (2004/09) Pp. 179-185

https://doi.org/10.6558/MTJM.2004.9(3).7

摘要

腎靜脈栓塞是一個少見的移植腎失敗的原因。它的發生率僅佔移植腎失敗的0.4％至1.2%。一旦發生，移植腎即難以挽回。最常見失敗的原因包括手術性問題、紅斑性狼瘡、抗磷脂質症候群（原發或續發於紅斑性狼瘡）以及腎病症候群。在此，我們報告一位因紅斑性狼瘡進入末期腎衰竭而接受屍腎移植的病例。手術後狀況不錯，直到術後第十天突然出現移植腎靜脈栓塞而導致該腎臟功能喪失。移植腎生檢顯示移植腎充血。移植腎摘除後的手術切片確診為腎靜脈栓塞。抗磷脂質症候群的抗體（IgG以及IgM）均為陰性。因此我們不認為此為導致腎靜脈栓塞的原因。因手術過程及術後切正常使我們排除了手術之技術性問題。病患術前唯一的異常為不正常高的紅斑性狼瘡指標（Anti-nDNA ,SS-A/SS-B）及持續性的全血球貧血。我們，建議紅斑性狼瘡的患者或應等到血漿的紅斑性狼瘡指標降至正常值時，再行接受腎移植。對於紅斑性狼瘡的移植腎靜脈栓塞，而與抗磷脂質症候群無關者，應做進一步的病因學研究。

關鍵字

腎靜脈栓塞 ； 腎臟移植 ； 紅斑性浪瘡

並列摘要

Renal vein thrombosis (RVT) is an uncommon cause of allograft failure. Although it occurs in only 0.4% to 1.2% of post-transplant surgeries, graft failure inevitably ensues once RVT develops. The most common causes of RVT include systemic lupus nephritis (SLE), antiphospholipid syndrome (APS), either primary or secondary to SLE, and severe nephrotic syndrome. Herein, we present a patient with endstage kidney disease (ESRD) caused by lupus nephritis who received a cadaveric renal transplantation. The patient had an uneventful course until renal vein thrombosis developed 10 days after transplantation, which resulted in loss of function of the grafted kidney. Renal pathology revealed congestive renal parenchyma. Diagnosis was confirmed by graft nephrectomy, which revealed multiple thrombotic renal venules. The APS serum markers including IgG/IgM antiphospholids antibody were normal. Therefore, we did not attribute the RVT to antiphospholipid syndrome. We also excluded any technical faults from being the cause because the operation had been performed smoothly. The only pre-operative abnormalities in this patient were abnormally high titers of lupus markers (Anti-nDNA and SS-A/SS-B) and pancytopenia. However, the patient still remains free of clinical lupus symptoms. We conclude that renal transplantation in an SLE patient should not be performed until acceptable low serum lupus markers are achieved. Further studies of the pathogenesis of SLE-related RVT rather than an APS-induced RVT are warranted.

並列關鍵字

renal vein thrombosis ； renal transplantation ； SLE