Collapsing focal segmental glomerulosclerosis in a liver transplant recipient on alendronate.
Collapsing focal segmental glomerulosclerosis in a liver transplant recipient on alendronate.
复制标题
接受阿仑膦酸钠治疗的肝移植受者出现局灶性节段性肾小球硬化塌陷。
DOI：
10.1007/s00198-007-0361-9
复制
发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Djamali,A
中科院分区：
文献类型：
--
作者：
Pascual,J;Torrealba,J;Myers,J;Tome,S;Samaniego,M;Musat,A;Djamali,A
我们描述了一个崩溃局灶节段性肾小球硬化症和严重的肾功能不全的情况下，肝移植受体后，阿仑膦酸钠开始骨质疏松症。鉴于长期肝移植患者中慢性肾脏疾病的发病率增加，在这些患者中需要谨慎使用双膦酸盐。越来越多的报道表明，双膦酸盐类药物可预防肝移植术后早期骨丢失。然而，关于这些药物在肝移植后期使用时的安全性和有效性的信息很少，特别是在存在慢性肾脏疾病的情况下。双膦酸盐在到达体循环后以原型通过肾脏排泄。已经描述了一些与使用帕米膦酸盐相关的严重肾损伤病例，特别是塌陷性局灶节段性肾小球硬化。阿仑膦酸钠是一种广泛用于移植患者的双膦酸盐，与肾毒性无关。我们描述了一个崩溃局灶节段性肾小球硬化症和严重的肾功能不全的情况下，肝移植受体后不久，阿仑膦酸钠开始骨质疏松症。可能的发病机制进行了讨论。鉴于长期肝移植患者中慢性肾脏疾病的发病率增加，在肾小球滤过率低的患者中需要谨慎使用双膦酸盐。
We describe a case of collapsing focal segmental glomerulosclerosis and severe kidney dysfunction in a liver transplant recipient after the initiation of alendronate for osteopenia. In view of the increasing incidence of chronic kidney disease in long-term liver transplant patients, bisphosphonates need to be used with caution in these patients. The usefulness of bisphosphonates for the prevention of early bone loss after liver transplantation is increasingly reported. However, there is little information on the safety and efficacy of these drugs when used in the later stages of liver transplant, particularly in the presence of chronic kidney disease. Bisphosphonates are excreted unchanged via the kidneys after reaching the systemic circulation. Some cases of severe kidney injury, in particular collapsing focal segmental glomerulosclerosis, have been described that are associated with the use of pamidronate. Alendronate, a widely used bisphosphonate in transplant patients, has not been related to kidney toxicity. We describe a case of collapsing focal segmental glomerulosclerosis and severe kidney dysfunction in a liver transplant recipient soon after the initiation of alendronate for osteopenia. Possible pathogenetic mechanisms are discussed. In view of the increasing incidence of chronic kidney disease in long-term liver transplant patients, bisphosphonate need to be used with caution in patients with a low glomerular filtration rate.