氯沙坦加肾衰宁治疗慢性肾衰竭的疗效观察

慢性肾衰竭 (CRF)的终末期主要靠透析或肾移植来维持生命 ,此时费用昂贵 ,副反应多 ,病人难耐受 ,而且随时危及生命。延长CRF的非透析期 ,保护肾功能是关键。CRF时除常规处理外 ,应用ACEI类和AngⅡ受体拮抗剂(ARA) [1,2 ] 或护肾中药已取得一定疗效 ,作者对 90例CRF早中期的患者随机分为 3组用氯沙坦和肾衰宁及二者组合进行临床观察比较 ,疗效良好 ,现报道如下。资料与方法1　病例选择　本院 1999年 6月～ 2 0 0 2年 5月住院和门诊患者共 90例。女 37例 ,男 5 3例 ,年龄 2 6岁～ 74岁 ,为肾功能不全失代偿期和肾衰竭期[3 ] 。其中…     

氯沙坦及辛伐他汀对慢性肾衰竭患者C-反应蛋白的影响

目的观察慢性。肾衰竭（CRF）患者血清C－反应蛋白（CRP）及生化指标的变化;探讨CRP在CRF病程进展及其并发症发生中的作用以及氯沙坦、辛伐他汀对CRF患者的影响。方法将120例CRF患者随机分为4组：A组（常规治疗组）;B组（常规治疗加氯沙坦100mg／d）;C组（常规治疗加辛伐他汀20mg／d）;D组（常规治疗加氯沙坦100mg／d,加辛伐他汀20mg／d）,同时设E组（健康对照组）20例。测定各组治疗前和治疗4周后各指标的水平。结果CRF患者治疗前的CRP几何均数显著高于E组。A、B、C、D组治疗后CRP、尿素氮（BUN）、血肌酐（SCr）水平有所下降,A、B组治疗前后总胆固醇（TC）、低密度脂蛋白（LDL）水平无明显改变,但C、D组治疗前后组内比较有统计学意义。B、C、D组分别与A组相比,CRP、BUN、SCr治疗前后差值比较,差异有统计学意义。B组TC、LDL下降值与A组比较无明显差异,但C、D组与A组相比,差异有统计学意义。CRP与BUN、TC、LDL具有正相关性,与血红蛋白（Hb）、白蛋白（Alb）具有显著负相关性,与SCr之间无相关性。结论①CRF患者CRP普遍升高;②CRP水平升高可能是CRF患者慢性贫血、营养不良、动脉粥样硬化等合并症的原因之一;③在某种程度上氯沙坦、辛伐他汀具有独立于降血压、降血脂以外的降低CRP、延缓。肾衰竭进展的作用。     

蛋白尿和慢性肾功能衰竭进展关系研究近况

蛋白尿不仅是肾脏疾病的结果，而且在肾脏慢性病变的进行性发展中独立地起重要作用。     

蛋白尿和慢性肾功能衰竭进展关系研究近况

蛋白尿不仅是肾脏疾病的结果，而且在肾脏慢性病变的进行性发展中独立地起重要作用。这些作用包括：①尿蛋白对肾小球系膜细胞和肾小管上皮细胞的直接毒性；②尿蛋白本身或通过其诱导巨噬细胞和肾小管上皮细胞产生趋化物质，使炎症细胞浸润间质，继发肾组织损伤；③尿蛋白刺激系膜细胞及肾小管上皮细胞产生多种细胞因子，促使肾小管上皮细胞合成和分泌细胞外基质蛋白，导致基质蛋白的大量沉积和肾间质纤维化。本文综述了蛋白尿在慢性肾脏病变进行性发展到慢性肾功能衰竭过程中的作用及其作用机理     

氯沙坦对原发性高血压患者微量蛋白尿的影响

目的 研究氯沙坦对原发性高血压患者微量蛋白尿的影响.方法 选自2008年6月～2010年12月在笔者所在医院诊断为原发性高血压的52例患者,随机分成两组,其中,A组每天服用科素亚50mg,B组每天服用科素亚100mg,1个月后观察各组的患者的微量蛋白尿的含量.结果 A组的降压及微量蛋白尿减少情况不如B组.结论 经氯沙坦治疗后患者尿微量蛋白皆有不同程度地下降,较大剂量氯沙坦对微量蛋白尿减少有更明显的影响.     

氯沙坦治疗早中期慢性肾衰竭疗效观察

高血压、蛋白尿是多数慢性肾衰竭(CRF)患者病情进展的主要原因之一.有研究已证实,降低蛋白尿及有效控制血压是延缓慢性肾病进展的极为重要的环节[3].氯沙坦是一种新型的血管紧张素Ⅱ受体拮抗剂,能有效持续血压.本文应用氯沙坦治疗175例CRF患者,结果显示其在控制高血压、降低蛋白尿及肾功能改善等方面获得良好效果,未见严重不良反应.     

肾维宁冲剂对慢性肾衰竭患者机体细胞免疫和肾功能的影响

目的:探讨中药肾维宁冲剂对慢性肾衰竭(氮质血症期)患者机体细胞免疫功能和肾功能的影响.方法:将62例慢性肾衰竭(CRF)患者随机分成两组,治疗组32例予肾维宁冲剂,对照组30例予包醛氧淀粉.观察两组治疗前和治疗后3个月CD 3、CD 4、CD 8、CD 4/CD 8、IL-1、IL-2、IL-6和BUN、Scr、Ccr水平的变化.结果:治疗组治疗后CD 3、CD 4、CD 8、CD 4/CD 8、IL-2和Ccr均显著上升(P＜0.05),CD 8、IL-1、IL-6、BUN、Scr则明显下降(P＜0.05).对照组治疗前后对比,仅BUN明显下降(P＜0.05),其余无统计学差异(P＞0.05).结论:肾维宁冲剂具有提高CRF患者CD 3、CD 4、CD 8、CD 4/CD 8、IL-2、Ccr水平,降低CD 8、IL-1、IL-6、BUN、Scr水平的作用.有效地改善患者的细胞免疫功能和肾功能.     

黄芪注射液对慢性肾衰竭病人肾功能及内皮素的影响

慢性肾衰竭(CRF)为各种肾脏疾病持续发展的共同转归，处于慢性肾衰竭代偿期到氮质血症期病人的治疗，主要是以延缓肾衰竭进展，减慢病人进入终末肾衰竭的速度为目的。此时患者体内血管活性物质代谢紊乱以及由此引发的血流动力学异常，是促使其病情慢性渐进性发展的重要环节之一。内皮素(ET)是目前已知的体内最强的缩血管物质，在CRF中起着重要的病理生理作用。在临床中我们发现黄芪注射液在降低血ET水平，延缓肾功能进展方面有一定作用。     

脉络宁注射液对老年慢性肾衰竭患者血液流变性及肾功能影响的观察

老年慢性肾衰竭 (ＣＲＦ)的发生率随年龄增高而上升 ,病情重 ,合并症多 ,严重威协患者生命。我院肾内科于 1 997年 9月～ 1 999年 8月应用脉络宁注射液治疗 2 8例老年ＣＲＦ患者 ,观察ＣＲＦ患者治疗前后血压、血脂、血液流变性及肾功能的变化 ,现报告如下。临床资料1　病例　 2 8例老年ＣＲＦ患者中 ,男 1 7例 ,女 1 1例 ;年龄 6 2岁～ 83岁 ,平均 6 3 4岁 ;病程均超过 2年 (2年～ 1 4年 )。原发病 :慢性肾小球肾炎6例 ,高血压病 9例 ,糖尿病 9例 ,痛风性肾病 2例 ,多囊肾 1例 ,慢性肾盂肾炎 1例。2　诊断标准　根据 1 992年全国肾小球疾…     

Losartan reduces proteinuria and preserves renal function in hypertensive patients with IgA nephropathy

Background. The objectives of this study were to evaluate the effects of the angiotensin II receptor antagonist losartan on blood pressure (BP), proteinuria, and renal function in hypertensive patients with IgA nephropathy. Method. The study subjects comprised 18 patients with biopsy-proven IgA nephropathy with mild hypertension. Patients were classified into three groups (good/relatively good, relatively poor, poor) according to renal histologic findings and treated once a day with losartan 50 mg for 12 months. Changes in BP, proteinuria, renal function, and biochemical parameters were prospectively evaluated before and after the treatment. Results. BP began to fall after 1 month and proteinuria decreased significantly after 9 months of therapy. Glomerular filtration rate (GFR), renal plasma flow (RPF), and filtration fraction (FF) did not change throughout the observation period. There was no significant difference between the three different histologic groups in relation to the effects of losartan on BP, proteinuria, and renal function. We found that in patients with a proteinuria reduction rate of more than 50%, RPF increased and FF decreased significantly. Although it has been reported that losartan has a uric acid lowering effect, this study could not confirm such an effect. Conclusions. Losartan lowers blood pressure and decreases proteinuria in hypertensive patients with IgA nephropathy. These effects appear to be independent of renal histologic findings. This study suggests that the antiproteinuric effect of losartan is primarily mediated by changes in glomerular hemodynamics. Received: April 13, 2001/Accepted: July 15, 2002 Correspondence to:H. Ohashi     

Some effects of preservation and acute renal failure on function and proteinuria of renal transplants

We assessed the effects of preservation on subsequent graft function by measuring and comparing creatinine and fractional protein clearances in 18 live-related (LR) and 38 cadaver-donor (CD) grafts, the latter selected on the basis of short warm ischemia times (less than 5 mins) and stable donor hemodynamic status prior to organ recovery. CD recipients with immediate graft function had lower initial creatinine clearances and greater fractional protein clearances than LR recipients. The role of preservation in producing greater fractional protein clearance was suggested by the observation of time-dependent increasing proteinuria during continuous hypothermic perfusion of four human CD kidneys and the significant correlation between the initial degree of proteinuria at onset of diuresis and the duration of cold preservation of those CD kidneys with immediate function. One-half of CD grafts, however, manifested acute renal failure (ARF) after implantation and in these grafts no correlation between cold preservation duration and fractional protein clearance at onset of diuresis was noted. Development of ARF in CD grafts was associated with still lower creatinine clearances, but higher fractional protein clearances during the first week of diuresis. These effects of preservation and those of preceding ARF on fractional protein clearances were no longer noted 2 wk after onset of diuresis in nonrejecting CD grafts. These observations suggest the presence of preservation-induced injury to grafts even when "immediate function" occurs.     

Gastrointestinal function in chronic renal failure

Feeding problems, anorexia and vomiting are common in infants and children with chronic renal failure (CRF), and play a major role in the growth failure often found in this condition. However, the gastroenterological and nutritional aspects of CRF in children have received little attention, hence therapeutic interventions are usually empirical and often ineffective. Gastritis, duodenitis and peptic ulcer are often found in adults with CRF on regular haemodialysis and following renal transplantation. Despite persistent hypergastrinaemia, gastric acid secretion is decreased rather than increased in most of these patients, and active peptic disease appears to be promoted by the removal of the acid output inhibition (neutralisation of gastric acid by ammonia) that follows active treatment.Helicobacter pylori, on the other hand, does not seem to play a significant role in the pathogenesis of peptic disease in CRF. Gastro-oesophageal reflux has been found in about 70% of infants and children with CRF suffering from vomiting and feeding problems, and thus appears to be a major problem in these patients. In a number of symptomatic patients with CRF, gastric dysrhythmias and delaved gastric emptying have also been found; hence there appears to be a complex disorder of gastrointestinal motility in CRF. Serum levels of several polypeptide hormones involved in the modulation of gastrointestinal motility [e.g. gastrin, cholecystokinin (CCK), neurotensin] and the regulation of hunger and satiety (e.g. glucagon, CCK) are significantly raised as a consequence of renal insufficiency, and can be reverted to normal by renal transplantation. Furthermore, several other humoral abnormalities (e.g. hypercalcaemia, hypokalaemia, acidosis, etc.) are not uncommon in CRF. By directly affecting the smooth muscle of the gut or stimulating particular areas within the central nervous system, all these humoral alterations may well play a major role in the gastrointestinal dysmotility, anorexia, nausea and vomiting in patients with CRF. Specific pharmacological and nutritional interventions should thus be considered for the treatment of vomiting and feeding problems in CRF.     

Haemostatic activation and proteinuria as factors in the progression of chronic renal failure

Haemostatic activation was measured in patients with either non-diabetic chronic renal failure (CRF) or diabetic nephropathy. We have investigated the relationship between these haemostatic markers and the rate of progression of renal failure. When compared with age- and sex-matched healthy controls, both patient groups showed significantly elevated plasma concentrations of D dimer, von Willebrand factor antigen (vWFAg), and C-reactive protein (CRP) (all P less than 0.001), as well as an increase in spontaneous platelet aggregation (P less than 0.01). Plasma concentration of platelet factor 4 was slightly but not significantly increased. Serum thromboxane was subnormal (P less than 0.01). Multiple regression analysis showed that in non-diabetic CRF proteinuria and serum TxB2 were independently related to the rate of progression of renal failure; in diabetic nephropathy proteinuria and vWFAg were independently related to the rate of progression. In both groups the relationship was stronger with proteinuria (standardised regression coefficients 0.56 and 0.45 respectively) than with serum TxB2 (0.29) or with vWFAg (0.37). We have found haemostatic activation in both non-diabetic and diabetic progressive renal failure. Proteinuria, and also in this study serum TxB2 and vWFAg, appear to be determining factors in the progression of renal failure, and their measurement may have prognostic value.     

Vesicoureteral reflux, proteinuria and renal failure

We report 3 cases of proteinuria, progressive renal insufficiency and vesicoureteral reflux with no history of urinary tract infection. Renal histology showed focal segmental glomerulosclerosis. These associations are unusual during childhood but they are common in adults. Generally, vesicoureteral reflux is discovered during radiological evaluation of children with recurrent urinary tract infections. Renal parenchymal damage in children typically results from recurrent infection or progressive hydronephrosis. Development of proteinuria with vesicoureteral reflux usually indicates an irreversible glomerular lesion. Antireflux surgery in patients with vesicoureteral reflux and decreased renal function may be beneficial if performed before the onset of proteinuria. We recommend antireflux surgery for children with persistent vesicoureteral reflux or decreased renal function.     

贝那普利对慢性肾功能衰竭患者血管内皮功能的影响

目的:研究贝那普利对慢性肾功能衰竭(CRF)患者血清内皮素(ET)、一氧化氮(NO)的影响。方法:将我院收治的256例慢性肾功能衰竭患者随机分为两组,常规治疗组121例采用常规治疗,贝那普利组135例采用常规治疗联合贝那普利治疗,观察治疗前后血清ET、NO改变,并与常规治疗组相比较。结果:常规治疗组治疗前后血清ET、NO水平差异没有统计学意义(P>0.05),贝那普利治疗后,其血清ET、NO均显著下降,与治疗前相比较,差异有统计学意义(P<0.05)。结论:贝那普利能够降低CRF患者血清ET、NO水平,可改善慢性肾衰竭患者血管内皮的功能。     

Obesity, proteinuria and progression of renal failure

PURPOSE OF REVIEW: Recent studies have reported an alarming increase in the incidence of obesity-related glomerulopathy, in a context of a worldwide spread of obesity. RECENT FINDINGS: Several epidemiological investigations have confirmed that obesity is a significant risk factor for the appearance of proteinuria and end-stage renal disease in a normal population. Obesity-induced hemodynamic changes and glomerular deposition of lipids (partly mediated by sterol regulatory element-binding proteins) play an important role in the pathogenesis of obesity-related renal disease. In addition, the renin-angiotensin-aldosterone system is markedly activated in obesity, adipocytes being an important source of these hormones. Weight loss induces a marked reduction in all renin-angiotensin-aldosterone system components. Patients with reduced renal mass of any origin appeared to be particularly susceptible to the detrimental influence of obesity: body mass index was the most important risk factor for the development of proteinuria and renal insufficiency in patients with unilateral renal agenesis, unilateral nephrectomy and remnant kidneys. Weight loss induces a very important reduction in proteinuria in chronic proteinuric nephropathies of different etiologies. SUMMARY: Prevention and treatment of obesity should be a first-line objective in the therapeutic approach of patients with diabetic and nondiabetic chronic renal diseases.     

低硒对慢性肾功能衰竭患者甲状腺功能的影响

已经证实，缺硒可使Ⅰ型脱碘酶（ID-Ⅰ）活性减弱，导致T4转化为T3受阻，T3下降。肾功能衰竭患者血硒及甲状腺激素（TH）水平均降低，且2者具有相关性。我们对40例慢性肾功能衰竭（CRF）患者全血硒、血清氧化指标、TH及甲状旁腺激素（PTH）含量进行了检测，并分析其相关性，旨在探讨血硒对CRF患者甲状腺功能的影响及其临床意义。