慢性肾功能衰竭62例可逆因素分析

我院近9年来收治慢性肾功能衰竭（CRF）患者62例,现分析其可逆因素以提高本病的治疗水平。回临床资料1．1一般资料62例中男47例,女15例;年龄14～70岁,平均37岁。病程6～14年,平均IO年。实验室检查G士）：血红蛋白（72．4士18．2）g／I。,血尿素氮（35．4士14．2）mmol／I,,肌酥（76．3土27O．1）pmo川,;尿培养35例,ZI例有致病菌生长。1．2原发病慢性肾小球肾炎37例,占59．7％;慢性肾盂肾炎9例,占14．5％;尿路结石7例,占11．3％;高血压肾小动脉硬化和糖尿病肾病各3例,肾结核2例,先天性多囊肾1例。豆．3CRF加速及加…     

泻浊化瘀扶正法对慢性肾功能衰竭急性加重患者C-反应蛋白和血清补体的影响及其干预作用

目的：观察泻浊化瘀扶正法治疗慢性肾功能衰竭（CRF）伴急性加重的临床疗效。方法：选择未行透析的CRF伴近期急性加重患者40例，按随机数字表法分为两组：治疗组22例，采用中药内服（由大黄、黄芪、白术、茯苓、当归、丹参、红花、川芎、木香、泽泻、生地、山楂组成）及中药灌肠（由大黄、黄连、黄芩组成）联合治疗；对照组18例，采用口服爱西特治疗；两组均治疗30d。观察两组临床疗效、肾功能及C-反应蛋白和血清补体的变化。结果：治疗组显效率（31．82％）、总有效率（77．27％）均明显高于对照组（16．66％和44．44％），两组总有效率比较差异有显著性（P〈O．05）。治疗组治疗后倦怠乏力、腰膝酸痛、纳少腹胀、恶心呕吐、头晕头痛等症状积分较治疗前均显著下降，且前3个症状较对照组治疗后也显著下降（P〈O．05或P〈O．01）。治疗后24h尿蛋白定量、血尿素氮、血肌酐、内生肌酐清除率以及血清补体C3、C4、CH50和C-反应蛋白也均较治疗前明显改善，且较对照组改善程度为好，差异均有显著性（P〈O．05或P〈O．01）；未见明显不良反应发生。结论：泻浊化瘀扶正法能明显减轻CRF急性加重患者恶化的肾功能及炎症反应，从而延缓肾功能衰竭的进展。     

184例慢性肾功能衰竭的病因分析

慢性肾功能衰竭（CRF）是各种病因引起的肾脏损害和进行性恶化的结果。导致慢性肾功能衰竭的病因有原发性和继发性两方面。因而早期诊断和治疗原发病十分重要c现将我院肾内科199o～1997年收治的慢性肾功能衰竭患者184例分析如下。l临床资料本组184例中男98例，女86例，男女之比为1．】：l；年龄20～86岁，平均59．6岁。进入透析阶段123例，非透析治疗问例。全部患者临床均有轻重不等的贫血貌、纳差、恶心、呕吐等。实验室检查：血红蛋白73．3土31．so／L，血肌酥83O9士415．sumo／L，血尿素氮24．4土9．gmmo几，血肌研清除率0．24土0．17…     

腹膜透析患者转血液透析原因及预后分析

目的分析腹膜透析患者转血液透析的原因，并探讨影响其预后的因素。方法回顾性分析上海长征医院1999年至2008年39例腹膜透析患者转血液透析的原因，并分析在我院行血液透析的23例患者的预后。结果共有39例腹膜透析患者转血液透析，腹膜透析治疗平均时间（14．4±16．3）月。转血液透析的原因为：透析不充分（30．8％）、技术失败（28．2％）、腹膜透析相关感染（25．6％）、失超滤（10.3％）。在我院行血液透析的23例患者中有12例死亡，11例维持性血液透析治疗。死亡原因主要为心脑血管事件和感染，糖尿病患者平均存活时间明显低于慢性肾炎患者。结论腹膜透析患者转血液透析的主要原因是透析不充分、技术失败和腹膜透析相关感染。原发病类型可能影响转血液透析后患者存活时间，糖尿病肾病患者预后较慢性肾炎患者差。     

慢性肾功能衰竭肾脏声像图分析

慢性肾功能衰竭（CRF）是指慢性肾脏疾病或累及肾脏的全身性疾病所引起的慢性肾功能减退综合症候群。其均有不同程度肾小球硬化，肾小管萎缩，间质纤维化，致使肾脏缩小，并随着病情加重而恶化最终发展致肾萎缩。本文对111例CRF各期患者的肾脏超声检查结果进行了分析，从而探讨CRF的肾脏声像图变化。1资料和方法1．1一般资料：本组111例（222只肾）均为1992～1997年在本院住院的CRF病人，其中男70例，女41例，平均年龄45．2（19～65）岁。原发病：慢性肾小球肾炎36例，慢性肾盂肾炎21例，糖尿病性肾病24例，高血压肾硬化15例，狼疮性肾…     

腹膜透析治疗老年慢性肾衰竭43例分析

2001／2006年我院对老年慢性肾功能衰竭（CRF）患者43例采用腹膜透析治疗，取得了较好疗效。分析如下。 1临床资料 1．1一般资料本组男25例，女18例，年龄60～82岁。原发病为慢性肾炎13例，高血压肾病12例，糖尿病肾病10例，慢性间质性肾炎8例。根据患者病史、体征、辅助检查等均符合CRF诊断，并达到腹膜透析的标准。     

应用透析登记系统对维持性血液透析患者临终前终止透析治疗的现况调查

目的 回顾性调查维持性血液透析患者临终前是否终止透析治疗及原因,与相应支持治疗情况.方法 应用上海市透析登记系统及原始存档病历收集1998.1.1至2012.12.31期间在上海交通大学医学院附属仁济医院浦西血液透析中心所有死亡血液透析患者.比较提前终止透析与未终止透析患者性别、年龄、透析龄、原发病、死亡原因等情况,并对提前终止血液透析患者的终止原因及支持治疗进行分析.结果 共收集维持性血液透析死亡患者115例,年龄64.6± 14.2岁,中位透析龄5.4（0.3～21）年,其中男性69例,占60％.原发病前3位分别是：慢性肾小球肾炎（27.8％）、高血压肾硬化（23.5％）、糖尿病肾病（12.2％）.死亡原因以脑血管意外（39.1％）、感染（15.7％）、心血管事件（10.4％）、猝死（8.7％）和晚期肿瘤（8.7％）为主.共9例（8％）提前终止透析患者,其中男性7例（77.8％）,女性2例（22.2％）,终止透析后中位存活天数为8.1天.终止透析原因：4例因晚期肿瘤恶液质终止透析,1例为严重感染,1例为脑血管意外,1例为技术原因无法继续给予肾替代治疗,另2例因经济因素患者本人要求终止透析.9例患者均给予相应的支持治疗措施. 结论 透析登记系统是了解临终期血液透析患者终止透析治疗的有效工具.上海交通大学医学院附属仁济医院浦西血液透析中心数据显示8％的临终患者选择了终止透析,远低于发达国家,提前终止透析组以晚期肿瘤为主要死亡原因.     

序贯结肠透析治疗慢性肾功能衰竭（CRF）短期疗效与分析

目的：观察序贯结肠透析对慢性肾功能衰竭，氮质血症期的短期治疗效果。方法．34例CRF，常规治疗的基础上加用序贯结肠透析治疗。具体方法：（1）口服大黄为主的制剂。（2）结肠透析隔天1次。（3）以大黄为主的方剂保留灌肠，隔天1次。观察临床表现演变，检测治疗前后血清尿素氮（BUN/mmol／L），肌酐（Scr，μmol）。尿酸（UA，μmol）及内生肌酐清除率（Ccr，ml／min）的水平。结果：治疗前后Scr、UA、Ccr、BUN均有明显差异。结论：对CRF氰质血症期患者加用序贯结肠透析治疗。效果显著，延缓开始透析时间，有较好的近期疗效。慢性肾功能衰竭（CRF）是一种常见的终末期肾脏病（ESRD）发病率为1／万。目前对CRF有效的治疗方法仍以透析和肾移植为主，但价格均十分昂贵，所以以药物阻止或延缓，慢性肾功能不全进入CRF终末期则显得非常重要，我科自2001年1月至2003年7月在常规治疗的同时加用序贯结肠透析，对34例CRF氮质血症期患者进行短期治疗观察，观察结果报告如下：     

疏血通注射液治疗慢性肾衰竭疗效观察

我们用疏血通注射液治疗慢性肾衰竭69例，取得满意的疗效，现报告如下。 1 对象和方法 1．1 对象慢性肾功能衰竭患者147例，均符合慢性肾功能衰竭（CRF）诊断标准，其中男98例，女46例，年龄21～82（平均48．4）岁。血肌酐178～707μmol／l。原发病；慢性肾炎105例，慢性肾盂肾炎患者3例，高血压肾病21例，糖尿病肾病15例。在观察期间行血液透析及使用其他扩血管药物治疗患者不列入研究。147例随机分为2组，治疗组69例，对照组78例。两组患者年龄、性别、原发病及肾功能损害程度方面均无显著差异。     

引起慢性肾功能不全急剧加重的相关因素及预防

慢性肾功能不全（chronic venal failure，CRF）是一个缓慢发展的过程，如果在短时间内迅速急剧加重，除考虑原发病加重外，还应特别注意是否存在加重因素。本文对2004年1月至2007年12月我院收治的的80例资料完整的CRF急剧加重患者的临床资料进行回顾性分析，探讨其加重因素及预防措施。     

How do we optimize the management of chronic renal failure?]

Optimization of the management of chronic renal failure (CRF) is aimed at decreasing morbidity and mortality risks of CRF patients, due to the progression of CRF toward end-stage renal disease (ESRD), and to CRF-related complications with functional or life-threatening consequences. The so-called spontaneous progression of CRF toward ESRD depends on factors related to the primary renal disease, and on non-specific factors mainly related to hypertension and renal functional adaptations to nephron loss. Secondary prevention of CRF needs: early identification of primary renal disease, in order to start specific therapies; the treatment of hypertension; dietary advice on protein intake; prevention of events and drug toxicity potentially harmful to renal function. Clinical events appear late in the course of CRF, following several disorders often present for a long time: hypertension, dyslipidemia, phosphocalcic disorders, anaemia, malnutrition). These disorders should be screened for, and treated, as a part of tertiary prevention measures. When dialysis becomes unavoidable, early information and medical preparation of the patient are mandatory, giving the best chances of success to the applied dialysis method. Unfortunately, most CRF patients are referred at a late stage of the disease, when the effects of therapeutic interventions are limited; this results in increased length of hospital stays, increased risk of early dialysis complications, and decreased capacity to be treated at home.     

肾小管泌氢功能检测在肾移植对抗排斥反应治疗效果中的应用

背景：移植后的急性排斥是肾移植术后的主要并发症，也是导致慢性排斥反应和移植物失功最重要的危险因素，因此，了解肾小管泌氢功能能否早期反映移植物的功能情况有重要意义。目的：观察肾移植患者术后肾小管泌氢功能，并进行监测，探讨其在移植物急慢性排斥中的作用。设计：病例-对照观察。单位：解放军济南军区总医院泌尿外科。对象：选择2000—05／2005—06解放军济南军区总医院泌尿外科连续实施肾脏移植26例患者，男16例，女10例；年龄21～58岁，平均35岁。原发病均为慢性肾小球肾炎，慢性肾功能衰竭，全部为尸肾移植。供受者均血型相同、淋巴细胞毒试验阴性。其中1例为第2次移植。所有患者对检测项目知情同意。方法：依据典型的临床表现，彩色多普勒超声及血流变化诊断患者排斥反应，16例患者未发生排斥反应为稳定组，10例发生排斥反应的患者为排斥组，排斥组根据排斥情况分为排斥前期、排斥期及恢复期。对所有患者术前及术后1周起每周1次，连续10周分别以化学清洁玻璃瓶留取晨起中段尿测定尿可滴定酸、NH4^＋和净酸水平评估肾小管泌氢功能。主要观察指标：两组患者尿可滴定酸、NH4^＋和净酸水平。结果：纳入患者26例均进入结果分析。排斥反应组排斥前期患者肾小管泌氢功能各检测值显示泌氢功能开始建立，并趋向正常，排斥期患者肾小管泌氢功能检测值均显示明显下降，与排斥前期及稳定组比较均有统计学显著性差异（P〈0．01）。恢复期患者排斥反应治疗后监测的结果显示泌氢功能恢复较快。肾小管泌氢功能总体连续观察结果显示总体恢复的不均衡性，大部分病例恢复时间从1～10周不等，平均恢复期限约6周，2例10周内未恢复，4例严重排斥者中3例治疗后泌氢功能恢复缓慢。结论：肾小管泌氢功能可弥补血清肌酐不能良好反映肾小管功能的不足，能在连续观察中对移植肾急性排斥反应的诊断，特别是对抗排斥治疗的效果判断和预后评估中作为有价值的指标。     

调节性T细胞对肾脏疾病的影响

目的研究调节性T细胞(CD4+CD25+)在肾脏疾病中的作用。方法选择住院患者72例,其中,原发性肾病综合征26例,慢性肾小球肾炎29例,其他原因致慢性肾功能衰竭17例;患者在接受治疗前检测血常规、生化分析、C反应蛋白(CRP)、凝血象和CD4+CD25+。结果肾病综合征组(肾功能正常者),CD4+CD25+%与D-二聚体负相关(P<0.01)。慢性肾小球肾炎组(肾功能正常者),CD4+CD25+%与CRP、PT、PT-INR、TT及D-二聚体正相关(均P<0.01)。慢性肾功能衰竭组,CD4+CD25+%与PT、D-二聚体正相关(P<0.05,0.01)。结论肾病综合征患者CD4+CD25+可减轻肾病综合征的病情发展;但CD4+CD25+对慢性肾小球肾炎和慢性肾功能衰竭患者,有改善机体凝血功能的作用。     

移植肾穿刺20例活组织病理检查的临床价值

背景:根据临床表现、无创性辅助检查及临床经验来判断肾移植后移植肾功能异常的原因常常会陷入困境,经皮肾穿刺活组织检查则可提供重要的循证学依据。目的:探讨移植肾穿刺活组织检查的临床意义。方法:回顾性分析20例移植肾穿刺活检病理资料及相应调整治疗后的临床结果资料。结果与结论:20例患者病理诊断为急性排斥反应7例(35%),可疑性急性排斥反应2例(10%),可疑性急性排斥反应加免疫抑制剂中毒1例(5%),免疫抑制剂中毒3例(15%),慢性移植肾肾病3例(15%),未见明确异常3例(15%),肾小管坏死1例(5%)。相应调整治疗方案后,移植肾功能恢复正常9例(45%),移植肾功能好转7例(35%),肾功能无明显变化3例(15%),肾功能轻度恶化1例(5%)。结果可见肾穿刺活组织检查对肾移植后肾功能异常的病因诊断有重要的价值,有利于指导治疗方案的调整。     

心脏手术与急性肾功能不全

目的　分析心脏手术后急性肾功能不全的原因 ,提出围手术期的处理要点。方法　对 13 45例心脏手术后发生肾功能不全的 2 82例的临床资料进行分析 ,其中轻度肾功能不全 189例 ,中度 69例 ,重度 14例 ,极重度 10例。结果　总的肾功能不全的发生率 2 0 97% (2 82 /13 45 ) ,总住院死亡率 3 712 % (4 2 /13 45 ) ,2 82例肾功能不全患者住院死亡 2 4例(8 5 1% ) ,术前伴发病、心功能分级、手术种类和心肺转流时间与术后肾功能不全的发生率有显著差异。结论　心脏手术后肾功能不全的发生和轻重程度 ,与术前伴发病、心功能分级、手术种类和心肺转流时间有密切关系。轻度、中度肾功能不全以强心、利尿、扩血管、保护肾功能为主 ,中度和重度肾功能不全者以腹膜透析为主 ,部分重度和极重度肾功能不全者以血液透析治疗为主     

Use of angiotensin-converting enzyme inhibitors in chronic kidney insufficiency

AIM: To study effects of ACE inhibitors in patients with diffuse renal diseases at the stage of chronic renal failure (CRF). MATERIAL AND METHODS: Acute changes in renal filtration and in renal hemodynamics in response to 100-200 mg captopril were studied in 7 patients with CRF and 6 patients with intact renal function. Effects of long-term ACE inhibitors were retrospectively studied in 50 patients with CRF (27 men, 23 women, mean age 46.0 +/- 1.9 years, 7 patients were over 60 years old). Sixteen patients were selected from this group who were followed up for a long time. They were examined for CRF progression rate when given conventional antihypertensive treatment and after treatment with ACE inhibitors. RESULTS: Acute response to ACE inhibitors was the following: SCF fell by 18.4% on the average by the end on therapy week 1; by the end of week 3 renal hemodynamics showed stability, SCF returned to normal, effective renal plasm flow rose by 16.9%, serum potassium rose significantly after 7 days of treatment but did not reach 6 mmol/l. Effects of long-term ACE inhibitor in CRF: the treatment was discontinued after 30-60 days in 12 of 50 patients because of high creatinine (> 20%); in 38 patients ACE inhibitor had a pronounced antihypertensive and antiproteinuric action for 2-3 years, creatinine growth inhibited. Progression of CRF became slow. CONCLUSION: ACE-inhibitors in CRF had a nephroprotective effect but blood creatinine levels should be controlled especially within the first 1-2 months of treatment.     

Cardiac troponins in renal failure – time for an optimistic consensus?

Elevated cardiac troponin concentrations are now accepted as the gold standard biochemical markers for the diagnosis of myocardial damage in patients with unstable coronary syndromes, having also a demonstrated value in early risk stratification and in adopting different therapeutic strategies. The specificity and sensitivity of cardiac troponins for diagnosis of acute coronary diseases in renal failure have been a point of confusion over the past decade, mainly because of moderate elevations of these cardiac biomarkers, commonly observed in patients with chronic renal dysfunction and without any significant myocardial damage. This review discusses the cardiac troponins, their biochemistry, their currently accepted cut-off values and their real significance in chronic renal failure (CRF), concluding that troponins maintain their diagnostic and prognostic values in patients with CRF, being predictive not only of cardiovascular mortality but also of general mortality in this patient group.     

The effect of enterosorbents on stomach functional activity and the parameters of nitrogen metabolism in patients with nephrogenous gastropathies]

The therapeutic efficacy of the continuous 6-week application of the enterosorbents CKH-4M and CKT-6A was traced in 64 patients with chronic renal diseases and different stages of chronic renal failure (CRF). The treatment was established to be most effective in the early stages of CRF. The morphologically verified manifest nephrogenic gastropathy was often associated with lack of the therapeutic effect and deterioration of the clinico-laboratory characteristics. Enterosorption brought about a decrease of ammonia concentration in gastric juice coupled with a positive time course of changes in dyspeptic disorders in such patients.     

三七总皂苷对慢性肾衰竭患者尿白蛋白的影响

目的 观察三七总皂苷治疗慢性肾衰竭(CRF)的临床疗效. 方法 将60例CRF(非尿毒症期)患者按入院顺序1:1随机分为观察组和对照组,每组30例.观察组在一般对症治疗基础上给予三七总皂苷提取物血栓通0.45 g,每日1次;对照组给予百令胶囊1.0 g,每日3次;两组均治疗2个月.观察治疗前后两组肾功能、血红蛋白、24 h尿蛋白定量、甲状旁腺素(PTH)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)的变化. 结果 两组患者治疗后血肌酐(SCr)、内生肌酐清除率(CCr)、尿素氮(BUN)、血尿酸(UA)、血红蛋白、24 h尿蛋白定量均较治疗前有不同程度改善,以观察组CCr、BUN、血红蛋白、24 h尿蛋白定量变化更为明显[CCr(ml/s):0.36±0.13比0.34±0.12,BUN(mmol/L):15.66±9.05比20.32±8.30,血红蛋白(g/L):101.2±9.4比95.4±8.7,24 h尿蛋白定量(mg):1 040±450比2 360±390,均P<0.05];而两组治疗后PTH、NAG中仅对照组NAG(U/L)较治疗前明显下降(18.2±9.8比28.9±12.0,P<0.05). 结论 三七总皂苷是治疗CRF(非尿毒症期)的有效药物,具有改善肾功能、减少尿蛋白等作用.     

Hyperhomocysteinemia and end-stage renal disease: determinants and association with cardiovascular disease in Tunisian patients.

The study reports on plasma total homocysteine (tHcy) levels in Tunisian patients with chronic renal failure (CRF) and those treated with hemodialysis (HD) and renal transplant (RT). The aims of the study were to identify the determinants of tHcy concentration and to test the association between hyperhomocysteinemia and atherothrombotic disease in end-stage renal disease (ESRD). A total of 35 CRF patients on conservative treatment, 50 HD patients, and 30 RT recipients, and 31 age- and sex-matched healthy subjects were included. Plasma tHcy was assessed by a fluorescent-polarizing immunoassay method. Multivariate analysis was applied to identify the main determinants of tHcy concentration and to assess the relationship between hyperhomocysteinemia and cardiovascular disease. Plasma mean tHcy concentration was significantly increased (p < 0.001) in CRF patients (mean +/- SD) (28.9 +/- 9.8 micromol/l), in HD patients (29.4 +/- 11.1 micromol/l), and in RT (19.3 +/- 6.3 micromol/l) patients compared to controls (11.9 +/- 4.1 micromol/l). Multivariate analysis using GLM ANOVA modeling demonstrated that tHcy was significantly higher in males (p = 0.02), and was related to age (p = 0.008), albumin (p = 0.005), vitamin B12 (p = 0.002), folate (p = 0.00001), and creatinine clearance (p = 0.0008). However, tHcy was not associated with C-reactive protein and did not significantly differ between CRF, HD, or RT patients. The upper quartile of tHcy concentration was significantly associated with atherothrombotic cardiovascular disease (unadjusted odds ratio (OR) = 3.09; 95% CI, 1.11-8.61; p = 0.01). This association remained significant after adjusting for sex, age, hypertension, and smoking (multi-adjusted OR = 4.78; 95% CI, 1.92-11.9; p = 0.0008). The mean tHcy concentration was 2 to 3 times higher in ESRD patients than in subjects with normal renal function. This increase could be related to glomerular filtration rate reduction and functional B vitamins deficiency, but was not associated with inflammation. The upper quartile of tHcy concentrations confers 4.78-fold increased independent risk for atherothrombotic events in ESRD patients.