低蛋白饮食对环孢素A肾病大鼠肾间质纤维化的作用

Objective To investigate whether low-protein diet has protective effect on the progression of renal interstitial fibrosis in rats with cyclosporine A (CsA)-induced nephropathy. Methods Eighteen male Sprague-Dawley rats were randomly divided into three groups (6 rats in each group). The rats in control group (C group) received common diet; in model group (M group) low-salt diet; in intervention group (Ⅰ group) low-salt and low-protein diet. After diet adaptation period of one week, the rats in C group received subcutaneous injection of olive oil 1 mg/kg daily for 5 weeks, while M group and Ⅰ group subcutaneous injection of CsA (diluted into 25 g/L with olive oil) 1 ml/kg for 5 weeks. All the rats were sacrificed at the end of the 5th week. The food-intake and body weight were measured daily. The creatinine clearance (Ccr) was examined before rats were sacrificed. The semi-quantitative pathological analysis on kidney sections was performed. The mRNA and protein expression of transforming growth factor-β1 (TGF-βI) and type Ⅰ collagen (Col Ⅰ) in kidney tissue was determined with real time PCR and immunohistochemical staining, respectively. Results The food-intake and body weight of rats in M and I groups were significantly lower than those in C group (P<0.05). Compared with C group, the Ccr levels in M and Ⅰ groups were significantly reduced [(0.65±0.15) ml/min, (0.40+0.13) ml/min vs (1.55±0.29) ml/min, P<0.05], the relative fibrosis areas of kidney interstitium in M and I groups were significantly increased (3.60%±0.46%, 3.26%±0.75% vs 0.44%±0.24%, P<0.05), the mRNA and protein expression of TGF-β1 in M and I group was significantly up-regulated (by 2.6 and 3.1 times in mRNA and by 1.5 and 1.6 times in protein, respectively, P<0.05), and the mRNA and protein expression of Col Ⅰ in M and I groups was also significantly up-regulated (by 3.0 and 3.5 times in mRNA and by 2.3 and 2.1 times in protein, respectively, P<0.05). There were no significant differences between M and I groups in every parameters above-mentioned except the rat body weight and Ccr. Both the body weight and Ccr in Ⅰ group were significantly lower than those in M group (P<0.05). Compared with C group, the urine osmotic pressure in M group and in I group were deceased (for M group, P>0.05; for I group, P<0.05). Compared with C group, the serum cholesterol levels in M and I groups were significantly increased (P<0.05), and the serum phosphorus level in I group was significantly decreased (P<0.05). The levels of serum albumin and serum calcium of all three groups had no statistical differences (P>0.05). Conclusion Low-protein diet has no renoprutective effects on the rat model of cyclosporin A nephropathy, on the contrary, may induce body weight loss.     

慢性肾脏病蛋白营养治疗共识

一、营养治疗对慢性肾脏病的意义　限制蛋白质饮食是治疗慢性肾脏病（CKD）、特别是慢性肾衰竭的一个重要环节.在施行低蛋白饮食、尤其极低蛋白饮食治疗时,为防止营养不良,建议给病人同时补充复方α-酮酸制剂或必需氨基酸制剂.但是,已有研究表明,补充复方α-酮酸制剂在延缓肾损害进展上疗效优于必需氨基酸制剂.     

多发性骨髓瘤肾损害

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急性间质性肾炎

急性间质性肾炎(Acute InterstitialNephritis,AIN)是一种临床病理综合征,是急性肾衰竭(ARF)的重要原因之一,约占ARF的10％～15％。往往急性起病,以肾间质炎性细胞浸润、水肿伴有小管上皮细胞退行性变、坏死为病理特征。临床表现有轻有重,大多数AIN有明确的病因,去除病因,及时治疗,疾病可痊愈或使病情得到不同程度的逆转。     

BMP-7与肾脏保护作用

骨形成蛋白-7(BMP-7)对肾脏的胚胎发育和维持肾脏正常生理功能有重要作用.在多个肾脏疾病模型中,肾组织中BMP-7的表达明显下降,而给予外源性BMP-7后能减轻肾脏损伤的发生和发展.BMP-7亦可能与慢性肾衰竭时肾性骨病及血管钙化的发生有密切关系.本文就BMP-7肾脏保护作用的研究进展作一综述.     

局灶性节段性狼疮肾炎

Baldwin 等1970年将狼疮肾炎按组织学分为局灶增殖、弥漫增殖和膜性等3型,随后又有作者增加了微小系膜病变(minimal mesangial lesion)型。虽然多数学者认为微小系膜性狼疮肾炎多呈良性病程,弥漫性狼疮肾炎多导致肾衰,但有关局灶性狼疮肾炎的预后仍存在不同看法。本文严格遵照世界卫生组织(WHO)的分类标准,从200例已作肾活检的系统性红斑狼疮患者中,选15例(7%)符合局灶性节段性狼疮肾炎诊断标准的患者,进行2～20(平均6.3)年的追踪观察,然后将其组织学变化联系临床过程(蛋白尿、高血压及肾功能的变化)进行综合分析。此15例的19次肾活检标本及1次尸体肾标本都经光学显微镜检查,其中17次肾活检标本还进行了电子显微镜检查,7次肾活检标本进行了免疫荧光显微镜     

糖尿病肾病要尽早防治

糖尿病肾病要尽早防治谌贻璞北京医科大学肾脏病研究所（１０００３４）近代，糖尿病发病率显著增加，在西方国家尤为明显，所以其主要并发症之一──糖尿病肾病近年已倍受重视。糖尿病损害肾脏一般按如下阶段进展：①肾小球高滤过。②微量白蛋白尿：从间歇性渐发展成持续...     

低镁综合征的诊断和治疗——附胆道术后低镁征1例报告

本文报告了1例胆道术后低镁综合征的诊断、治疗经过,并结合文献复习对低镁综合征的发病机理、临床表现、诊断与治疗进行了讨论。指出该综合征并非罕见,提高对本综合征的认识和对可疑病例提高警惕是早期诊断和正确治疗的关键。大剂量滴注镁剂治疗本病,一般说来是有效和安全的。     

系膜IgM肾病

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