糖尿病肾病治疗的其他方法和进展

常规治疗糖尿病肾病的主要措施为:控制血糖,血压,调脂,饮食治疗(限制蛋白质摄入),戒烟,抗凝,肾脏替代治疗(透析治疗和肾脏移植)等.尽管这些治疗能够延缓部分患者的肾病进展,但是总体治疗效果还是不理想.目前,人们对糖尿病肾病发生机制的研究已经有了长足的进步,相应地也出现了一些防治糖尿病肾病的新药物.     

第一届肾素论坛会议纪要

自1898年Robert Tigerstedt教授第一次发现并命名"肾素"至今,针对肾素-血管紧张素系统(RAS)的研究已经有100余年了.时至今日,人们已经认识到,RAS在调节血压、维持水钠平衡及肾脏发育等方面起着重要的作用,并参与人体诸多病理生理过程.     

高尿酸血症及其肾损伤

高尿酸血症系指正常嘌呤饮食情况下，非同日2次空腹血清尿酸含量男性和绝经期女性〉420μmol／L，绝经前女性〉357μmol／L。国内随着国民生活水平迅速提高和饮食结构改变，我国高尿酸血症发病率显著增长。国内尚无高尿酸血症的确切发病率，发达国家中正常人群中的高尿酸血症比例约为5％。     

糖尿病合并慢性肾功能不全患者血糖管理的特殊要求

慢性肾脏病(CKD)[ 包括糖尿病肾病(DN)] 患者常以不同速度逐渐进展至慢性肾功能不全(CRI),乃至终末期 肾衰竭,此时糖尿病(DM) 患者的血糖管理有着许多特殊要求。该文介绍了以下相关注意事项： (1) 慢性肾功能不 全(CRI) 时糖化血红蛋白(HbA1c) 检测结果可能出现偏差,此时宜选用糖化白蛋白检测;另外, CRI 患者易发生低 血糖,故治疗糖尿病(DM) 时HbA1c 目标值应＞ 7%,并应个体化地进行制定。(2) 为了避免低血糖发生,此时治疗宜 选用短效胰岛素,从小剂量开始,在密切监测血糖变化下适时调整用量,直至血糖达标。(3) 以肾脏排泄为主的降糖 药,当患者有CRI 时需依据肾功能受损程度,相应减少药物用量或停药,以免药物体内蓄积,造成严重副反应。     

我国成人原发性肾病综合征系列研究

原发性肾病综合征(PNS)是肾内科常见病症,在住院病例中占重要地位。但80年代前国内对引起PNS的基础肾脏病及其不同治疗方案、对PNS的并发症及其防治措施都十分缺乏认识。15年来,我们在国家及教委3个基金资助下,在国内率先对成人PNS进行了系列研究,并与国内同道一起,将我国PNS的诊断与治疗推向了国际先进水平。     

肾功能不全患者冠心病的抗栓药物治疗

慢性肾脏病常并发冠心病,需要积极治疗包括抗栓药物治疗,以减少心血管事件发生率及病死率。但是,肾功能不全患者出血风险增加,如果抗栓药物使用不当,即可诱发严重出血。文章将对肾功能不全时如何使用抗血小板药物、抗凝药物及纤溶药物作一讨论。     

控制高血压阻断慢性肾脏病-高血压恶性循环

一、慢性肾脏病(CKD)及其流行病学概况 美国肾脏基金会2002年制订的K/DOQI"慢性肾脏病临床实践指南"将CKD定义如下:肾脏损伤(血、尿成分异常、或影像学检杳异常、或病理学检查异常)≥3个月,有或无肾小球滤过率(GFR)异常;GFR<60 ml·min-1·1.73m-2≥3个月,有或无肾脏损伤证据.     

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.