肥満を伴う生体腎移植ドナーの短期腎予後
「I. 緒言」肥満では糸球体過剰濾過などを原因として, 病理学的には糸球体肥大や巣状分節性硬化症を呈し, 臨床的には蛋白尿や腎機能障害を生じる肥満関連腎症を発症することがある. そのため肥満の生体腎ドナーでは腎提供後, 糸球体過剰濾過が進行し, 腎機能障害のリスクが上昇することが危惧される. 海外の研究では生体腎ドナーで肥満は腎機能低下のリスクではないという報告や, 逆に肥満は腎機能低下のリスクであるという報告もあり, 一定した見解はない. また, これまで本邦での肥満の生体腎ドナーの詳細な報告はない. 今回われわれは肥満を伴う生体腎ドナーの短期腎予後について後ろ向き観察研究を行った. 「II...
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| Published in | Japanese Journal of Transplantation Vol. 52; no. 6; pp. 533 - 537 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本移植学会
2017
日本移植学会 The Japan Society for Transplantation |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0578-7947 2188-0034 |
| DOI | 10.11386/jst.52.6_533 |
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| Abstract | 「I. 緒言」肥満では糸球体過剰濾過などを原因として, 病理学的には糸球体肥大や巣状分節性硬化症を呈し, 臨床的には蛋白尿や腎機能障害を生じる肥満関連腎症を発症することがある. そのため肥満の生体腎ドナーでは腎提供後, 糸球体過剰濾過が進行し, 腎機能障害のリスクが上昇することが危惧される. 海外の研究では生体腎ドナーで肥満は腎機能低下のリスクではないという報告や, 逆に肥満は腎機能低下のリスクであるという報告もあり, 一定した見解はない. また, これまで本邦での肥満の生体腎ドナーの詳細な報告はない. 今回われわれは肥満を伴う生体腎ドナーの短期腎予後について後ろ向き観察研究を行った. 「II. 対象と方法」「1. 対象」2003年4月から2013年7月までの間に自治医科大学附属病院で生体腎ドナーとして腎提供した症例は168例であり, この内3年以上経過を追えた149例を対象とした. |
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| AbstractList | 「I. 緒言」肥満では糸球体過剰濾過などを原因として, 病理学的には糸球体肥大や巣状分節性硬化症を呈し, 臨床的には蛋白尿や腎機能障害を生じる肥満関連腎症を発症することがある. そのため肥満の生体腎ドナーでは腎提供後, 糸球体過剰濾過が進行し, 腎機能障害のリスクが上昇することが危惧される. 海外の研究では生体腎ドナーで肥満は腎機能低下のリスクではないという報告や, 逆に肥満は腎機能低下のリスクであるという報告もあり, 一定した見解はない. また, これまで本邦での肥満の生体腎ドナーの詳細な報告はない. 今回われわれは肥満を伴う生体腎ドナーの短期腎予後について後ろ向き観察研究を行った. 「II. 対象と方法」「1. 対象」2003年4月から2013年7月までの間に自治医科大学附属病院で生体腎ドナーとして腎提供した症例は168例であり, この内3年以上経過を追えた149例を対象とした. 【Objective】 Obesity may cause obesity-related nephropathy due to glomerular hyperfiltration and the like. There is concern that the risk of kidney injury may increase due to progression of glomerular hyperfiltration after nephrectomy of living kidney donors with obesity. We conducted a retrospective observational study on short-term renal prognosis of living kidney donors with obesity.【Methods】 Between April 2003 and July 2013, 149 living kidney donors who were followed 3 years or more were treated as BMI<25.0 kg/m2 (normal group), 25.0 kg/m2≤BMI<30.0 kg/m2 (obese group), or 30.0 kg/m2≤BMI (maximum 33.1 kg/m2) (highly obese group), and eGFR and proteinuria were compared.【Results】 Among the 149 donors, 100 normal subjects, 43 obese subjects and 6 highly obese subjects were included. There was no significant difference in the preoperative renal function or the observation period among the 3 groups. The eGFR after 1 year was 54.3±10.8 ml/min/1,73 m2, 51.3±10.3 ml/min/1,73 m2, and 57.3±12.2 ml/min/1,73 m2 (p=0.213), and the eGFR at the final examination was 55.0±11.8 ml/min/1,73 m2, 54.4±13.5 ml/min/1,73 m2, and 54.7±14.0 ml/min/1,73 m2 (p=0.978), and the protein urine appearance rates were 14.0%, 25.6% and 16.7% (p=0.223), respectively, and there was no significant difference.【Conclusion】 In this study, obese living kidney donors were not significantly different from non-obese living kidney donors in short-term renal prognosis. Further long-term observation and examination of more cases are necessary. |
| Author | 武藤, 重明 八木澤, 隆 南木, 浩二 新里, 高広 清水, 俊洋 石川, 暢夫 黒澤, 明 久保, 太郎 木村, 貴明 |
| Author_FL | SHIMIZU Toshihiro KIMURA Takaaki MUTO Shigeaki NANMOKU Koji KUBO Taro ISHIKAWA Nobuo YAGISAWA Takashi SHINZATO Takahiro KUROSAWA Akira |
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| References | 3) O’Brien B, Mastoridis S, Sabharwal A, et al. Expanding the donor pool: living donor nephrectomy in the elderly and the overweight. Transplantation 2012; 93: 1158-1165. 4) Chakkera HA, Chang YH, Thomas LF, et al. Obesity correlates with glomerulomegaly but is not associated with kidney dysfunction early after donation. Transplant Direct 2015; 1: 1-6. 6) Heimbach JK, Taler SJ, Prieto M, et al. Obesity in living kidney donors: clinical characteristics and outcomes in the era of laparoscopic donor nephrectomy. Am J Transplant 2005; 5: 1057-1064. 1) Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 2001; 59: 1498-1509. 9) 日本肥満学会．肥満症診断基準2011．日本肥満学会誌「肥満研究」臨時増刊号2011; 17. 2) Taner T, Iqbal CW, Textor SC, et al. Compensatory hypertrophy of the remaining kidney in medically complex living kidney donors over the long term. Transplantation 2015; 99: 555-559. 11) 清野 裕．糖尿病の分類と診断基準に関する委員会報告 (国際標準化対応版)．糖尿病2012; 55: 485-504. 13) Delmonico F, Council of the Transplantation Society. A report of the Amsterdam forum on the care of the live kidney donor: data and medical guidelines. Transplantation 2005; 79l: S53-66. 8) Locke JE, Reed RD, Massie A, et al. Obesity increases the risk of end-stage renal disease among living kidney donors. Kidney Int 2017; 91: 699-703 10) WORLD HEALTH ORGANIZATION, et al. Physical status: the use of and interpretation of anthropometry, report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995; 854: 1-452. 5) Rook M, Bosma RJ, van Son WJ, et al. Nephrectomy elicits impact of age and BMI on renal hemodynamics: lower postdonation reserve capacity in older or overweight kidney donors. Am J Transplant 2008; 10: 2077-2085. 7) Nogueira JM, Weir MR, Jacobs S, et al. A study of renal outcomes in African American living kidney donors. Transplantation 2009; 88: 1371-1376. 14) 両角國男．生体腎移植のドナーガイドライン．日本移植学会ホームページ．http://www.asas.or.jp/jst/pdf/manual/008.pdf 12) Hashimoto Y, Tanaka M, Okada H, et al. Metabolically healthy obesity and risk of incident CKD. Clin J Am Soc Nephrol 2015; 10: 578-583. |
| References_xml | – reference: 8) Locke JE, Reed RD, Massie A, et al. Obesity increases the risk of end-stage renal disease among living kidney donors. Kidney Int 2017; 91: 699-703 – reference: 5) Rook M, Bosma RJ, van Son WJ, et al. Nephrectomy elicits impact of age and BMI on renal hemodynamics: lower postdonation reserve capacity in older or overweight kidney donors. Am J Transplant 2008; 10: 2077-2085. – reference: 2) Taner T, Iqbal CW, Textor SC, et al. Compensatory hypertrophy of the remaining kidney in medically complex living kidney donors over the long term. Transplantation 2015; 99: 555-559. – reference: 7) Nogueira JM, Weir MR, Jacobs S, et al. A study of renal outcomes in African American living kidney donors. Transplantation 2009; 88: 1371-1376. – reference: 10) WORLD HEALTH ORGANIZATION, et al. Physical status: the use of and interpretation of anthropometry, report of a WHO Expert Committee. World Health Organ Tech Rep Ser 1995; 854: 1-452. – reference: 9) 日本肥満学会．肥満症診断基準2011．日本肥満学会誌「肥満研究」臨時増刊号2011; 17. – reference: 4) Chakkera HA, Chang YH, Thomas LF, et al. Obesity correlates with glomerulomegaly but is not associated with kidney dysfunction early after donation. Transplant Direct 2015; 1: 1-6. – reference: 1) Kambham N, Markowitz GS, Valeri AM, et al. Obesity-related glomerulopathy: an emerging epidemic. Kidney Int 2001; 59: 1498-1509. – reference: 3) O’Brien B, Mastoridis S, Sabharwal A, et al. Expanding the donor pool: living donor nephrectomy in the elderly and the overweight. Transplantation 2012; 93: 1158-1165. – reference: 14) 両角國男．生体腎移植のドナーガイドライン．日本移植学会ホームページ．http://www.asas.or.jp/jst/pdf/manual/008.pdf – reference: 6) Heimbach JK, Taler SJ, Prieto M, et al. Obesity in living kidney donors: clinical characteristics and outcomes in the era of laparoscopic donor nephrectomy. Am J Transplant 2005; 5: 1057-1064. – reference: 12) Hashimoto Y, Tanaka M, Okada H, et al. Metabolically healthy obesity and risk of incident CKD. Clin J Am Soc Nephrol 2015; 10: 578-583. – reference: 13) Delmonico F, Council of the Transplantation Society. A report of the Amsterdam forum on the care of the live kidney donor: data and medical guidelines. Transplantation 2005; 79l: S53-66. – reference: 11) 清野 裕．糖尿病の分類と診断基準に関する委員会報告 (国際標準化対応版)．糖尿病2012; 55: 485-504. |
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| Snippet | 「I. 緒言」肥満では糸球体過剰濾過などを原因として, 病理学的には糸球体肥大や巣状分節性硬化症を呈し, 臨床的には蛋白尿や腎機能障害を生じる肥満関連腎症を発症することがある. そのため肥満の生体腎ドナーでは腎提供後, 糸球体過剰濾過が進行し, 腎機能障害のリスクが上昇することが危惧される.... 【Objective】 Obesity may cause obesity-related nephropathy due to glomerular hyperfiltration and the like. There is concern that the risk of kidney injury may... |
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| Title | 肥満を伴う生体腎移植ドナーの短期腎予後 |
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