Mechanisms and amelioration of acute renal allograft failure in the cyclosporine era.
The fairly wide-ranging spectrum of tactics under investigation for ameliorating acute renal allograft dysfunction caused by harvest/preservation-related ischemia, acute CsA nephrotoxicity, and acute immunologic crises reflect the fact that no single approach has emerged as universally useful for mitigating the vasomotor nephropathy produced by the combined effects of each of these vectors of vasomotor renal allograft injury. Given the clinical heterogeneity of patients and allografts, it is the author's bias that, in addition to careful donor and recipient hemodynamic management, induction immunosuppressive regimens should be individualized on the basis of allograft function in the immediate postreperfusion period (judged by rate of diuresis, intraoperative parenchymal tone, renal scan profiles, and rate of decline of serum creatinine concentration) as well as patient-specific immunologic and general medical risk factors. Promising laboratory and clinical investigations of such agents as calcium channel blockers, substances promoting intrarenal vasodilator vs. vasoconstrictor prostaglandin formation, and atriopeptins have the potential to provide clinically helpful options with regard to adjunctive therapy for ameliorating acute renal allograft dysfunction associated with INF and ACR.
Lewis
R
R
Division of Urology, University of Texas Medical School, Houston.
Katz
S
S
Van Buren
C
C
Kerman
R
R
Kahan
B
B
D058186:Acute Kidney Injury / Q000209:etiology / Q000517:prevention & control*; D009320:Atrial Natriuretic Factor / Q000627:therapeutic use; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005919:Glomerular Filtration Rate / Q000502:physiology; D006084:Graft Rejection / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000502:physiology*; D009926:Organ Preservation; D010446:Peptide Fragments / Q000627:therapeutic use; D015427:Reperfusion Injury / Q000150:complications
D004232:Diuretics; D010446:Peptide Fragments; C042703:anaritide; D016572:Cyclosporine; D009320:Atrial Natriuretic Factor