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Том 2 №3 2000 год - Нефрология и диализ

Роль мофетила микофенолата в арсенале современных иммуносупрессивных препаратов


Корсакова Т.В.

Аннотация: С тех пор как для иммуносупрессии были внедрены такие препараты, как циклоспорин А (СуА) и такролимус (FK 506), аллотрансплантация почки стала методом выбора для большинства больных с терминальной почечной недостаточностью. Это определяется тем, что в сравнении с традиционными преднизолоном и азатиопорином (Аза) CyA и FK 506 обладают более высокой иммунодепрессивной активностью при снижении опасности тяжелых, подчас фатальных побочных эффектов. Как следствие, широкое внедрение их в клиническую трансплантологию способствовало увеличению выживаемости больных и увеличению доли функционирующих трансплантатов. Однако будучи высокоэффективными иммуносупрессантами [31, 44], эти препараты вызывают ряд серьезных токсических побочных эффектов [26]. Так, в настоящее время хорошо известна нефротоксичность СуА [5, 54], которая проявляется снижением скорости клубочковой фильтрации, канальцевым ацидозом и гиперурикемией [5, 11, 54]. Описаны и характерные морфологические признаки этого нефротоксического эффекта [46, 54]. Более того, показано, что в отдаленной перспективе хроническое нефротоксическое действие CyA может способствовать развитию хронической недостаточности трансплантата.

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Ключевые слова: селлсепт, трансплантация почки, кризы отторжения, хроническое отторжение

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