China's First Guideline For The Diagnosis And Treatment Of Long-term Complications Of Kidney Transplant Recipients Has Been Released. You Must Know About The Six Major Systemic Complications!
Jun 14, 2024
Hematologic complications
Recommendation 1: It is recommended to pay attention to anemia in kidney transplant recipients. Before treatment, the risk factors should be identified first, including decreased renal function, use of some immunosuppressive drugs, parvovirus infection, iron deficiency, etc. (recommendation strength B, evidence level 2a).
Recommendation 2: It is recommended that kidney transplant recipients first identify the cause of anemia and treat the cause (recommendation strength A, evidence level 1b).
Recommendation 3: Compared with non-transplant populations, kidney transplant recipients are more likely to develop post-transplant polycythemia (PTE). The risk factors include male sex, retention of the original kidney (sufficient erythrocyte production before transplantation), renal artery stenosis (original kidney or transplanted kidney), young age, dialysis before transplantation, immunosuppressive drugs and other drug use. It is recommended to comprehensively evaluate the risk factors of PTE to help clarify the diagnosis (recommendation strength B, evidence level 2b).
Recommendation 4: The treatment goal of PTE in kidney transplant recipients is to maintain the hematocrit continuously <0.45, and low-dose aspirin anticoagulation is used to reduce the risk of serious complications such as thromboembolism (recommendation strength B, evidence level 2b).
Click to Cistanche for kidney disease
Recommendation 5: It is recommended that PTE in kidney transplant recipients should first be treated for the cause. ACEI/ARB drugs are generally selected for initial treatment. If ineffective, aminophylline and 5-hydroxytryptamine type II receptor antagonists are selected (recommendation strength B, evidence level 2b).
Recommendation 6: If the hematocrit of kidney transplant recipients needs to be rapidly reduced in a short period of time, intermittent venous bloodletting therapy is recommended (recommendation strength C, evidence level 4).
Recommendation 7: It is recommended to pay attention to leukopenia in kidney transplant recipients. Its risk factors include bone marrow suppression caused by immunosuppressive drugs (azathioprine, MPA, cyclophosphamide, etc.), anti-thymocyte globulin, viral infection, and antibiotic use (recommendation strength B, evidence level 2b).
Recommendation 8: When treating leukopenia in kidney transplant recipients, it is recommended to first identify and eliminate the cause, and at the same time supplement the deficiency, stimulate growth, and prevent the occurrence of complications such as infectious diseases (recommendation strength B, evidence level 2b).
Recommendation 9: It is recommended to pay attention to thrombocytopenia in kidney transplant recipients. The main risk factors include immunosuppressive drugs, antibiotics or antiviral drugs, viral infections, etc. (recommendation strength B, evidence level 2b).
Recommendation 10: It is recommended that kidney transplant recipients pay close attention to the bleeding hazards of thrombocytopenia, especially life-threatening bleeding in important organs (recommendation strength B, evidence level 2a).
Recommendation 11: It is recommended to treat the cause of thrombocytopenia, including adjusting the immunosuppression regimen, controlling infection, supplementing vitamin B12, folic acid, recombinant thrombopoietin and platelet transfusion (recommendation strength B, evidence-level 2b).
Recommendation 12: It is recommended that kidney transplant recipients with thrombocytopenia caused by hypersplenism should undergo splenectomy when other treatments are ineffective (recommendation strength C, evidence level 4).
Recommendation 13: It is recommended that kidney transplant recipients with clinical manifestations such as fever and splenomegaly and laboratory test results such as pancytopenia and hypertriglyceridemia should consider the possibility of hemophagocytic syndrome, which should be identified and diagnosed as early as possible (recommendation strength C, evidence level 4).
Recommendation 14: It is recommended that kidney transplant recipients with hemophagocytic syndrome be diagnosed and treated early, and the primary disease should be treated. Transplant physicians should adjust the immunosuppression regimen and work with hematology specialists to control the progression of the disease (recommendation strength B, evidence level 2a).
Recommendation 15: It is recommended that kidney transplant recipients undergo plasma exchange for hemophagocytic syndrome and undergo transplant nephrectomy when necessary (recommendation strength C, evidence level 4).
Central nervous system complications
Recommendation 16: The incidence of acute stroke in kidney transplant recipients is significantly higher than that in non-transplant recipients. It is recommended that recipients with high-risk factors such as advanced age, diabetes, atrial fibrillation, hyperlipidemia, reduced left ventricular function, carotid artery stenosis, and long dialysis age be alert to the occurrence of acute stroke (recommendation strength B, evidence level 2a).
Recommendation 17: The treatment principles for acute stroke in kidney transplant recipients are the same as those in non-transplant recipients. It is recommended to complete head CT and other examinations as soon as possible, and to carry out relevant treatment in a timely manner according to the advice of specialists (recommendation strength A, evidence level 1a).
Recommendation 18: It is recommended that kidney transplant recipients with acute stroke should steadily lower blood pressure and control it to the target value, and avoid excessive lowering of blood pressure (recommendation strength A, evidence level 1b).
Recommendation 19: When kidney transplant recipients use mannitol to treat intracranial hypertension, it is recommended to individually formulate the dosage and course of treatment, dynamically monitor the glomerular filtration rate, and be alert to acute kidney injury in the transplanted kidney (recommendation strength B, evidence level 2b).
Recommendation 20: During the period of fasting and drinking in an acute stroke of kidney transplant recipients, it is recommended to give immunosuppressive drugs through a nasogastric tube to reduce the risk of acute rejection of transplanted kidney (recommendation strength D, evidence level 5).
Recommendation 21: The prevention principles of ischemic stroke in kidney transplant recipients refer to those of non-transplant populations, but it is recommended to give priority to direct-acting oral anticoagulants for drug prevention (recommendation strength B, evidence level 2b).
Recommendation 22: The prevention principles of hemorrhagic stroke in kidney transplant recipients refer to those of non-transplant populations, and it is recommended to choose a medication regimen based on calcium channel blockers to standardize blood pressure control (recommendation strength B, evidence level 2b).
Recommendation 23: The incidence of epilepsy in kidney transplant recipients is higher than that in non-transplant populations. Common risk factors include immunosuppressive drugs, infection, anti-infective drugs, water and electrolyte imbalance, etc. It is recommended to actively screen and treat common risk factors for epilepsy (recommendation strength C, evidence level 4).
Recommendation 24: The treatment principles for epilepsy in kidney transplant recipients refer to those for non-transplant recipients. It is recommended to actively treat with AEDs and effectively treat the causes of epilepsy (recommendation strength C, evidence level 4).
Recommendation 25: For epilepsy induced by immunosuppressive drugs, it is recommended to lower the dose of immunosuppressive drugs or switch immunosuppressive regimens (recommendation strength C, evidence level 4).
Recommendation 26: It is recommended that the AED treatment regimen be based on the type of epileptic seizure, adverse drug reactions, drug interactions, pharmacokinetics and other factors, and the type and dose of AED should be selected individually (recommendation strength C, evidence level 4).
Cardiovascular complications
Recommendation 27: Cardiovascular complications in kidney transplant recipients mainly include hypertension, hyperlipidemia, coronary artery atherosclerotic heart disease (CHD), heart failure, pulmonary hypertension, arrhythmia and valvular heart disease. Regular cardiovascular disease screening is recommended (recommendation strength D, evidence level 5).
Recommendation 28: It is recommended that immunosuppressive drugs, rejection reactions, and chronic allograft renal insufficiency be considered as specific risk factors for cardiovascular complications in kidney transplant recipients (recommendation strength D, evidence level 5).
Recommendation 29: It is recommended that kidney transplant recipients with risk factors for cardiovascular complications fully evaluate the effects of immunosuppressive drugs on traditional risk factors such as blood pressure, blood lipids, and blood sugar, and adjust the immunosuppressive regimen in a targeted manner to prevent the occurrence of cardiovascular complications (recommendation strength D, evidence level 5).
Recommendation 30: When choosing contrast agents, kidney transplant recipients are recommended to choose isotonic contrast agents first. Those with high-risk factors or iodine allergies should choose iodine-free, non-ionic, and low-osmolar contrast agents to reduce renal toxicity (recommendation strength D, evidence level 5). It is recommended to minimize the amount of contrast agents used to reduce the risk of renal injury (recommendation strength B, evidence level 2b).
Recommendation 31: It is recommended that kidney transplant recipients be fully hydrated and pretreated with statins when using contrast agents to effectively protect renal function (recommendation strength B, evidence level 2b).
Ocular complications
Recommendation 32: The incidence of cataracts in kidney transplant recipients is high, and its risk factors are cumulative hormone doses, CNI use, advanced age, and obesity. Regular ophthalmology outpatient follow-up, screening, and treatment are recommended (recommendation strength C, evidence level 4).
Recommendation 33: The treatment principles for cataracts in kidney transplant recipients are the same as those for non-transplant populations. There is currently no specific immunosuppressant adjustment program for cataracts in kidney transplant recipients. It is recommended to avoid repeated high-dose hormone regimens and make individualized assessments and adjustments (recommendation strength D, evidence level 5).
Skin complications
Recommendation 34: It is recommended to pay attention to benign skin diseases in kidney transplant recipients, mainly including acne, hirsutism, and infection (recommendation strength C, evidence level 4).
Recommendation 35: The occurrence of benign skin diseases in kidney transplant recipients is related to long-term use of hormones and (or) immunosuppressive drugs. It is recommended to receive treatment from a dermatologist and adjust hormone and immunosuppressive regimens as needed (recommendation strength B, evidence level 2b).
Recommendation 36: It is recommended that kidney transplant recipients receive physical treatments such as cryotherapy, electrocautery, laser, and photodynamic therapy for actinic keratosis, combined with drug therapy such as intralesional injection of α2 interferon, oral acitretin, topical application of 5% fluorouracil, diclofenac, etc. (recommendation strength B, evidence level 2b).
Recommendation 37: It is recommended that kidney transplant recipients undergo surgical resection as soon as possible when actinic keratosis is suspected to have a tendency to malignancy or has already become cancerous (recommendation strength B, evidence level 2b).
Complications of osteoporosis
Recommendation 38: Risk factors for osteoporosis in kidney transplant recipients include secondary hyperparathyroidism (HPT), diabetes, genetic susceptibility, and unhealthy lifestyles that are consistent with those in the non-transplant population, as well as CNI and hormone use. It is recommended that kidney transplant recipients undergo regular screening and evaluation based on their actual conditions (recommendation strength B, evidence level 2b).
Recommendation 39: It is recommended that kidney transplant recipients undergo early screening for osteoporosis. Preventive measures are similar to those for non-transplant recipients. A reasonable osteoporosis prevention plan should be formulated, and regular review and monitoring should be performed (recommendation strength A, evidence level 1b).
Recommendation 40: It is recommended that kidney transplant recipients with osteoporosis change their lifestyle, reasonably supplement calcium and vitamin D, use the lowest dose of hormone regimen, reasonably formulate an osteoporosis prevention plan, and regularly review and monitor (recommendation strength A, evidence level 1b).
How Does Cistanche Treat Kidney Disease?
Cistanche is a traditional Chinese herbal medicine used for centuries to treat various health conditions, including kidney disease. It is derived from the dried stems of Cistanche deserticola, a plant native to the deserts of China and Mongolia. The main active components of cistanche are phenylethanoid glycosides, echinacoside, and acteoside, which have been found to have beneficial effects on kidney health.
Kidney disease, also known as renal disease, refers to a condition in which the kidneys are not functioning properly. This can result in a buildup of waste products and toxins in the body, leading to various symptoms and complications. Cistanche may help treat kidney disease ase through several mechanisms.
Firstly, cistanche has been found to have diuretic properties, meaning it can increase urine production and help eliminate waste products from the body. This can help relieve the burden on the kidneys and prevent the buildup of toxins. By promoting diuresis, cistanche may also help Reduce high blood pressure, a common complication of kidney disease.
Moreover, cistanche has been shown to have antioxidant effects. Oxidative stress, caused by an imbalance between the production of free radicals and the body's antioxidant defenses, plays a key role in the progression of kidney disease. ies help neutralize free radicals and reduce Oxidative stress, thereby protecting the kidneys from damage. The phenylethanoid glycosides found in cistanche have been particularly effective in scavenging free radicals and inhibiting lipid peroxidation.
Additionally, cistanche has been found to have anti-inflammatory effects. Inflammation is another key factor in the development and progression of kidney disease. Cistanche's anti-inflammatory properties help reduce the production of pro-inflammatory cytokines and inhibit the activation of inflammation mandatory pathways, thus alleviating inflammation in the kidneys.
Furthermore, cistanche has been shown to have immunomodulatory effects. In kidney disease, the immune system can be dysregulated, leading to excessive inflammation and tissue damage. Cistanche helps regulate the immune response by modulating the production and activity of immune cells, such as T cells and macrophages. This immune regulation helps reduce inflammation and prevent further damage to the kidneys.
Moreover, cistanche has been found to improve renal function by promoting the regeneration of renal tubes with cells. Renal tubular epithelial cells play a crucial role in the filtration and reabsorption of waste products and electrolytes. In kidney disease, these cells can be damaged, leading to damaged renal function. Cistanche's ability to promote the regeneration of these cells helps restore proper renal function and improve overall kidney health.
In addition to these direct effects on the kidneys, cistanche has been found to have beneficial effects on other organs and systems in the body. This holistic approach to health is particularly important in kidney disease, as the condition often affects multiple organs and systems. che has been shown to have protective effects on the liver, heart, and blood vessels, which are commonly affected by kidney disease. By promoting the health of these organs, cistanche helps improve overall kidney function and prevent further complications.
In conclusion, cistanche is a traditional Chinese herbal medicine used for centuries to treat kidney disease. Its active components have diuretic, antioxidant, anti-inflammatory, immunomodulatory, and regenerative effects, which help improve renal function and protect the kidneys from further damage. , cistanche has beneficial effects on other organs and systems, making it a holistic approach to treating kidney disease.
