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首页> 美国卫生研究院文献>Healthcare >End Stage Renal Disease—A Nephrologist’s Perspective of Two Different Circumstances as Typified by Kidney Transplantation Experience in a Nigerian Hospital Versus a Large US Medical School
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End Stage Renal Disease—A Nephrologist’s Perspective of Two Different Circumstances as Typified by Kidney Transplantation Experience in a Nigerian Hospital Versus a Large US Medical School

机译：终末期肾脏疾病—肾脏科医生对两种不同情况的看法以尼日利亚一家医院与一家美国大型医学院的肾脏移植经验为代表

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Renal transplantation is the sine qua non consummate form of renal replacement therapy (RRT) for end stage renal disease (ESRD). Despite the increasing ESRD burden worldwide, developing countries continue to experience a gross lack of RRT options for its teeming citizens with ESRD. This report is a demonstration of a nephrologist’s experience and dilemma trying to make sense of the yawning disparity between RRT options, especially renal transplantation, as it applies to the citizens of the USA versus the citizens of Nigeria. The limited three-year experience of renal transplantation at Garki Hospital, located in Abuja, the capital of Nigeria, which is one of the very few centers carrying out renal transplantation in Nigeria, was starkly contrasted with this author’s first-hand experience at the University of Maryland Medical School, in Baltimore, Maryland, USA, as a Nephrology Fellow between 2000 and 2002. The potential role of public-private partnership (PPP) ventures in developing countries is considered as a way to help bridge this gap.Prologue:Just the other day, in late April 2017, during weekly scheduled hemodialysis rounds at one of the Mayo Clinic Dialysis Services outpatient hemodialysis units in Northwestern Wisconsin, this author was rounding on a pleasant 76-year old Caucasian widow who had been on dialysis since June 2016 for end stage renal disease (ESRD). Her other past medical history was notable for statin-induced myopathy, dyslipidemia, hyperuricemia, and gout, as well as peripheral vascular disease with previous bilateral femoral artery bypass procedures, a left knee meniscus repair, and unilateral renal artery stenosis, which was stented in November of 2013 and re-stented again in December of 2014. During the hemodialysis rounds, she had been asked how she was doing. “Today is my last day,” she had chuckled with a broad smile. She was getting a living kidney transplant in two days’ time at Mayo Clinic, Rochester. “The donor is my 49-year old daughter!” she added with an even broader smile. “I hope all goes well,” this author had intoned. “It will. It will,” she added, with glee.This tells the whole story; for the ESRD patient on thrice weekly hemodialysis, or any other renal replacement therapy (RRT) option for that matter, the act of getting a kidney transplant is a transformative phenomenon. “It is as if being born again,” one of my patients had noted previously.
机译：肾移植是终末期肾脏疾病（ESRD）的肾脏替代疗法（RRT）的正当性和非最佳形式。尽管全世界范围内的ESRD负担日益增加，但发展中国家仍然严重缺乏为其居民提供ESRD的RRT选择。这份报告证明了肾脏科医生的经验和困境，试图弄清RRT选项之间的巨大差距，尤其是肾移植，因为它适用于美国公民与尼日利亚公民。在尼日利亚首都阿布贾的Garki医院进行肾移植的三年经验有限，该医院是尼日利亚为数不多的进行肾脏移植的中心之一，与作者在大学的第一手经验形成鲜明对比。在2000年至2002年期间担任美国马里兰州巴尔的摩市马里兰医学院的肾脏病学研究员。公私合营（PPP）企业在发展中国家的潜在作用被认为是弥合这一差距的一种方式。前一天，即2017年4月下旬，在威斯康星州西北部梅奥诊所透析服务门诊血液透析单位的每周定期血液透析期间，这位作者正在采访一位自2016年6月以来一直在接受透析的76岁高加索寡妇用于终末期肾脏疾病（ESRD）。她的其他过往病史因他汀类药物引起的肌病，血脂异常，高尿酸血症和痛风，以及先前有双侧股动脉旁路手术，左膝半月板修复和单侧肾动脉狭窄的周围血管疾病（均已植入支架） 2013年11月，并在2014年12月再次支架。在血液透析期间，有人问她过得如何。 “今天是我的最后一天，”她笑了笑。两天后，她在罗切斯特的梅奥诊所进行了活体肾脏移植。 “捐助者是我49岁的女儿！”她笑得更加灿烂。 “我希望一切顺利，”这位作者语调不足。 “它会。她会高兴地补充道。对于每周进行三次血液透析的ESRD患者，或对此进行任何其他肾脏替代治疗（RRT）的患者，进行肾脏移植的行为是一种转化现象。我的一位患者以前曾说过：“就好像重生一样。”

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