成人肾病综合征：诊断和治疗

在肾病综合征中,众多的功能紊乱会导致蛋白尿,进而引起高度水肿和低蛋白血症。而高脂血症是一个常见的伴随症状。家庭医师会遇到由原发（或先天）的肾脏疾病引起,或者由许多继发性原因导致肾病综合征的患者,在专家会诊之前要进行恰当的诊断和医药治疗。     

血清胱抑素C水平对老年冠状动脉介入术后患者造影剂诱导急性肾损伤发生及其远期预后的影响

目的:探讨胱抑素C(CysC)水平对老年冠状动脉介入治疗(PCI)患者术后造影剂诱导的急性肾损伤(CI-AKI)发生及其远期预后的影响。方法:前瞻性连续入选2015年3月至2017年12月间在我院心内科接受PCI治疗的老年患者848例,CI-AKI定义为应用碘造影剂48～72 h内血清肌酐升高≥44.2 μmol/L,...     

中医从咽论治IgA肾病研究进展

临床上,IgA肾病患者常出现咽痛或咽部不适症状,需引起重视。中医治疗IgA肾病多以咽部为切入点,常用药中有较多疏风清热、解毒利咽之药,如桔梗、蒲公英、牛蒡子等,具有一定疗效,同时也可配合啄治法增强疗效。     

Nephrosis in two siblings with infantile sialic acid storage disease

The diagnosis of infantile sialic acid storage disease (ISSD) was established in two siblings on the basis of typical clinical signs and the biochemical findings of hyperexcretion and intracellular storage of free sialic acid. A severe, steroid resistant nephrosis occurred in both siblings. The activities of lysosomal enzymes, including sialidase, were normal. A combined detection method for sialic acids withLimax flavus agglutinin labelling and phosphotungstic acid staining showed severely alterated sialic acid components in epithelial kidney cells and indicate a causal relationship between the nephrosis and the underlying biochemical defect. Further observations of ISSD patients with renal involvement will prove if a separate nephropathic phenotype exists.     

The immune system in minimal change nephrotic syndrome

Numerous examples of abnormal immune responsiveness have been described in minimal change nephrotic syndrome (MCNS). The association of MCNS with allergy and with certain genetic markers of immune responsiveness, as well as the excellent response of proteinuria to immunomodulatory agents, has suggested a causal relationship between the immunological and renal abnormalities. However, the nature of this relationship is uncertain. Before it can be clarified, the basic mechanism(s) involved in disturbed immunity in patients with MCNS must be better characterized. Studies of humoral and cellular immune function support the hypothesis that immune regulation is abnormal. However, conclusive evidence of participation by a defined immunoregulatory system in the events leading to immune dysfunction has not been obtained. Thus, considerable work remains to be done in determining the nature and cause of abnormal immunity in MCNS prior to investigating its potential role in the pathogenesis of proteinuria.     

足细胞功能紊乱与微小病变性肾病

微小病变性肾病(MCD)是肾病综合征常见的病理类型之一,其病理主要表现为肾小球脏层上皮细胞足突广泛融合。目前越来越多的研究表明,足细胞损伤是MCD蛋白尿产生的关键环节。在MCD小鼠模型及人肾组织中均发现,足细胞裂隙膜蛋白nephrin、podocin和骨架蛋白synaptopodin的表达下调,且蛋白尿的多少与其表达下降程度相关;synaptopodin表达越多,患者对激素治疗反应越好。近年来,关于MCD足细胞损伤的焦点集中于足细胞来源的两种蛋白:CD80和血管生成素样蛋白4。来自外界的微生物或抗原作用于足细胞,通过激活κB基因序列致CD80过表达,进而破坏足细胞骨架蛋白,改变肾小球滤过率,引起蛋白尿;过表达的血管生成素样蛋白4可破坏肾小球基底膜电荷屏障,导致足突融合,诱发MCD。但有关诱发CD80和血管生成素样蛋白4持续过表达的关键因素以及两者与肾小球基底膜之间相互作用的具体致病过程并不明确,有待更深入的研究证实。基于MCD足细胞损伤机制的研究,NF-κB抑制剂和唾液酸化治疗措施在不久的将来也许可以作为MCD的一种新型的非免疫治疗方案。     

M‐2000, as a New Anti‐inflammatory Molecule in Treatment of Experimental Nephrosis

The therapeutic effect of M‐2000 (C6H10O7) molecule was tested in Adriamycin‐induced nephropathy. To induce experimental nephrosis, Adriamycin was given once by a single intravenous injection (7.5 mg/kg) through the tail vein. Six days after injection of Adriamycin, therapeutic protocol was developed by intraperitoneally (i.p) administration of 30 mg/kg M‐2000 solution. Total of i.p. injections were 14, in which five injections were made every day and nine injections were carried out at regular 48‐h intervals. Therapeutic protocol was terminated on day 28 and animals were killed on day 43. The treated patient rats showed a significant reduction in proteinuria, BUN, serum creatinine and serum cholesterol, as well as, administration of M‐2000 could significantly diminish the serum level of interleukin‐6 (IL‐6) in treated animals compared to non‐treated controls. Moreover, treatment with M‐2000 significantly reduced number of glomerular leukocytes, Hypercellularity and hydropic change in capillary network within the renal cortex and decreased tubular casts. These data suggest that M‐2000 therapy can ameliorate proteinuria, and suppress the progression of glomerular lesions in experimental model of nephrosis.     

终末期肾病患者初次自体动静脉内瘘手术失败的原因分析

目的 探讨终末期肾病患者初次自体动静脉内瘘(AVF)手术失败的原因及预防措施.方法 选取行初次自体AVF手术的终末期肾病患者819例,收集患者术前血红蛋白(Hb)、白蛋白(ALB)、胆固醇(CHOL)、甲状旁腺素(PTH)、空腹血糖以及血压情况,同时在术前行上肢血管超声,检测患者桡动脉和头静脉内径.结果 742例患者AVF手术成功,77例患者AVF手术失败,AVF手术失败患者年龄、糖尿病、高血压、血压＜120/70 mm Hg(1 mm Hg=0.133 kPa)比例显著高于AVF手术成功患者[(61.3±13.4)岁比(45.6±11.2)岁、46.8％(36/77)比31.7％(235H42)、26.0％(20/77)比19.5％ (145/742)、36.4％ (28/77)比9.2％ (68/742)],差异有统计学意义(P ＜0.05或＜0.01)；AVF手术失败患者头静脉、桡动脉内径显著低于AVF手术成功患者[(1.35±0.64) mm比(1.98±0.47) mm、(2.13±0.81) mm 比(2.47±0.74) mm],差异有统计学意义(P＜0.01)；AVF手术失败患者PTH水平显著高于AVF手术成功患者[(782.39±423.85) ng/L比(378.83±352.21)ng/L],差异有统计学意义(P＜0.05).Logistic多元线性回归分析显示血压、糖尿病、PTH、头静脉内径、桡动脉内径是AVF手术失败的危险因素.结论 自体AVF手术失败与患者血压、原发病、需要吻合的血管内径、PTH水平有一定相关性.     

Protective effect of Sunset Abelmoschus on podocyte injury in adriamycin?induced nephropathy rats

Objective To explore the effect of Sunset Abelmoschus on podocyte injury in adriamycin?induced nephropathy rats. Methods Fifty male SD rats were randomly divided into five groups: sham operation group (n=10), model group (n=10), Sunset Abelmoschus low dose group (0.5 g•kg-1•d-1 n=10), middle dose group (1.0 g•kg-1•d-1, n=10) and high dose group (2.0 g•kg-1•d-1, n=10). Unilateral nephrectomy combined repeated adriamycin injection were performed to establish adriamycin?induced nephropathy models. The rats were administered with the corresponding dose of Sunset Abelmoschus during the experiment period. Urinary protein, urinary N?acetyl glucose aminotransferase (NAG), serum albumin, serum creatinine and blood lipid were measured before operation and 2, 4, 6, 8 weeks after operation. The rats were sacrificed on week 8 for the renal histological examination, including light microscope and electron microscope. Expression of nephrin was examined by immunofluorescence assays. Results As compared to model group, urinary protein and NAG significantly decreases in Sunset Abelmoschus groups in each time point, especially in high dose group (P<0.01), meanwhile the serum albumin increased and the disturbance of lipid metabolism was improved in Sunset Abelmoschus groups (P<0.05). Compared with sham group, Scr increased significantly in model group and Sunset Abelmoschus groups at the 4th week. At the 8th week, Scr in high dose group was lower than that in model group (P<0.05), and the ratio of glomerular globe sclerosis and segmental sclerosis, tubulointerstitial damage reduced in Sunset Abelmoschus groups, especially in high dose group. The podocyte damage and the extent of foot process fusion were improved in Sunset Abelmoschus groups compared with model group. Expression of nephrin increased in Sunset Abelmoschus groups than that in model group. Conclusion Sunset Abelmoschus can ameliorate proteinuria and renal tissue damage of adriamycin?induced nephropathy rats, whose mechanism may be associated with the improvement of podocyte injury.     

肾病综合征患者胆碱酯酶与白蛋白比值临床意义的探讨

目的探讨血清胆碱酯酶(CHE)与血清白蛋白(ALB)比值检测在肾病综合征患者中的临床应用价值。方法对抚顺市中心医院2013年1~9月54例肾病综合征患者和71例排除肝脏疾病、心脏疾病、外科手术的患者及其他肾脏疾病的体检人员(对照组)进行外周血CHE、ALB检测,同时检测肾病综合征患者尿蛋白。结果肾病综合征患者中CHE、ALB、CHE/ALB比值与对照组组间比较差异有统计学意义(P<0.05);CHE/ALB对肾病综合征的诊断阳性率98.1%,并且与患者尿蛋白的量呈正相关(r=0.5687)。结论肾病综合征患者CHE/ALB比值增高可以做为肾病综合征的诊断标准,并反映肾病综合征的病情危重程度。