黄芩汤的临床应用医案四则

黄芩汤出自《伤寒论》,原文用于治疗下利。笔者曾跟师黄煌教授学习经方,根据黄煌老师经验结合个人体会,以唇红、眼睑充血、肛门灼热等黏膜充血为抓手,采用黄芩汤治疗不孕,黄芩汤合百合地黄汤治疗蛋白尿、血尿,黄芩汤加黄柏治疗热痹,黄芩汤原方治疗痛经等均取得了较好的疗效,本方值得进一步深入研究。     

Choriocarcinome gestationnel révélé par une métastase rénale

Gestational choriocarcinoma (GC) belongs to a group of gestational trophoblastic tumors. This rare tumor has a great metastatic potential and thus requires an early and adapted treatment. Herein We report a case of GC in a 35-year-old patient who presents with hematuria from a renal metastasis. Clinical improvement was noted after nephrectomy and chemotherapy. This observation underlines the importance of the dosage of the beta-HCG and the polymorphic clinical presentation of gestational choriocarcinoma.     

Hematuria duration does not predict kidney function at 1 year in ANCA-associated glomerulonephritis

Objectives

Hematuria is considered a marker of active renal disease in ANCA-associated glomerulonephritis (ANCA-GN) with induction immunosuppression often continued until hematuria has resolved. We aim to determine whether longer hematuria duration is associated with lower estimated glomerular filtration rate (eGFR) at 1 year.

Methods

We conducted a retrospective study of 55 patients with biopsy-proven ANCA-GN. Linear regression models were constructed to determine predictors of eGFR at 1 year. The primary exposure was hematuria (>5 rbc/hpf) duration, defined as <90 days vs. ≥90 days following renal biopsy. Covariates included age, gender, ANCA type, baseline eGFR, and baseline proteinuria.

Results

Mean age at diagnosis was 58 years (53% male, 80% Caucasian, 38% PR3-ANCA, and 45% MPO-ANCA). At baseline, all patients had hematuria, 95% had proteinuria, and mean serum creatinine was 3.1 [standard deviation (SD) = 2.3] mg/dL. Overall, 93% were treated with steroids in combination with either cyclophosphamide or rituximab. Mean hematuria duration was 92 (SD = 77) days with 34 (62%) patients having hematuria resolution within 90 days. Older age and lower baseline eGFR were associated with lower eGFR at 1 year (p = 0.03 and p < 0.001, respectively). Hematuria resolution (<90 days vs. ≥90 days) was not predictive of eGFR at 1 year (p = 0.93).

Conclusions

In ANCA-GN, hematuria duration does not predict eGFR at 1 year. Our findings provide support that among individuals who are otherwise considered to be in clinical remission, the persistence of hematuria should not delay transition from induction to maintenance immunosuppression.     

邵朝弟治疗肾小球性血尿经验

肾小球性血尿病机复杂,临证表现繁多,但总以阴虚生热者为主。邵老在重视本虚,强调阴虚病机在血尿中作用的同时,也注重气、血、水在本病演变中的作用。邵老认为,肾性血尿虽与阴虚有关,但血瘀、水湿却贯穿于疾病之始终,遣方用药时,在阴虚的基础上,以"滋阴清热,凉血止血"为大法自拟"血尿方",并灵活运用"活血、理气、行水"之法,环环相扣,随证加减,用之临床疗效卓著。     

Unenhanced versus multiphase MDCT in patients with hematuria, flank pain, and a negative ultrasound

Objectives

To compare the impact of unenhanced and contrast-enhanced multi-detector computed tomography (MDCT) for the detection of urinary stones and urinary obstruction in patients with suspected renal colic.

Methods

95 patients with suspected renal colic underwent a three-phase MDCT for evaluation of the urinary tract. The unenhanced scan and the multiphase examination were reviewed retrospectively by two radiologists for the characterization of urinary stones and signs of obstruction. Results of unenhanced MDCT were compared with those obtained during the second review of the entire multiphase examination.

Results

Overall diagnosis of urinary stones revealed an accuracy of 97.0% for unenhanced, and 98.9% for multiphase MDCT with a significant difference between both protocols (mixed-effects logistic regression: odds ratio 3.3; p = 0.019). With 3 versus 15 false positive ratings, multiphase MDCT was superior to unenhanced MDCT for the diagnosis of urinary stones.There was no significant difference in detecting signs of obstruction. Inter-reader agreement for overall stone detection was excellent on both unenhanced (kappa 0.84) and multiphase (kappa 0.88) MDCT.

Conclusion

Contrast-enhanced multiphase MDCT offers distinct advantages compared to an unenhanced approach for the assessment of urinary stone disease, and therefore should be considered as a complementary examination for patients with inconclusive findings.     

Diagnostic value of combined IQGAP3/BMP4 and IQGAP3/FAM107A expression ratios in urinary cell-free DNA for discriminating bladder cancer from hematuria

Background

Urinary cell-free DNA (ucfDNA) has great potential as a “liquid biopsy” for use in diagnosis of urological cancers. In this study, we compared ucfDNA gene expression levels between patients with bladder cancer (BC) and those with hematuria, and determined whether they could be used as a noninvasive urine-based marker.

Efectos adversos de la acumulación renal de hemoproteínas. Nuevas herramientas terapéuticas

Haemoglobin and myoglobin are haem proteins that play a key role as they help transport oxygen around the body. However, because of their chemical structure, these molecules can exert harmful effects when they are released massively into the bloodstream, as reported in certain pathological conditions associated with rhabdomyolysis or intravascular haemolysis. Once in the plasma, these haem proteins can be filtered and can accumulate in the kidney, where they become cytotoxic, particularly for the tubular epithelium, inducing acute kidney failure and chronic kidney disease. In this review, we will analyse the different pathological contexts that lead to the renal accumulation of these haem proteins, their relation to both acute and chronic loss of renal function, the pathophysiological mechanisms that cause adverse effects and the defence systems that counteract such actions. Finally, we will describe the different treatments currently used and present new therapeutic options based on the identification of new cellular and molecular targets, with particular emphasis on the numerous clinical trials that are currently ongoing.