肾功能试验的现况

肾脏不仅是一个排泄废物的器官,且参与水及电解质代谢,调节细胞外液容量相对稳定,还是一个内分泌器官,分泌肾素、前列腺素、缓激肽、促红素、1,25二羟维生素D等,因而肾功能试验涉及的范围较广。以下分几方面介绍。1 肾小球功能(1)肾小球滤过率(GFR)测定临床上用作测GFR的物质必须具有:①可自由通过肾小球滤过;②血浆中可达到稳定浓度;③不为肾脏重吸收、分泌或代谢。能满足此等条件的理想物质     

放射性核素检查在儿童肾功能检测中的应用

儿科核医学泌尿系检查除能提供肾脏及集尿系解剖结构信息外,还能获得重要生理功能参数,其中对肾功能测定尤有价值。这主要归因于有符合肾功能测定要求的放射性药物及放射性核素(核素)示踪、成像技术。核素方法检测儿童肾功能主要有肾小球滤过率(GFR)、有效肾血浆流量(ERPF)和肾图测定。现就这些检查原理、方法及临床应用作一简述。     

~(99m)Tc-DTPAγ摄影机肾脏造影对小儿肾功能与形态的评价

与15年前相比,二乙撑三胺五乙酸~(99m)锝(~(99m)Tc-DTPA)用于肾、脑闪烁造影已较多见。由于~(99m)Tc-DTPA 只通过肾小球滤过从血浆中排出,因此,注射~(99m)Tc-DTPA 后,通过它的血浆清除率测定就可获得肾小球滤过率(GFR)。运用~(99m)Tc-DTPAγ照相可获得相当出色的肾造影影片,可得到肾和尿路的影像,并可得到单个肾脏的总 GFR(相对肾功能)。对于成年人,无需采集血和尿标本,从肾造影就可准确地计算出 GFR(绝对肾功能)。然而,外部测量受几何形状的影响,因此,成人的这种方法未经校正而用于儿童是无效的。     

足月儿生后第1年内肾小球滤过的率测定

肌酐廓清试验是测定儿童肾小球滤过率(GFR)的一种有效的方法,然而其应用却受到需要完整地收尿集液和收集时间的限制。作者最近已报告儿童期的肌酐廓清率可以直接从血浆肌酐浓度和身长确定。准     

Schwartz公式推算原发性肾病综合征患儿肾小球滤过率

目的 了解原发性肾病综合征(PNS)患儿肾功能变化情况,比较肾小球滤过率(GFR)、血浆尿素氮(BUN)和肌酐清除率(Cr)对肾功能的评价作用.方法 使用酶法测定203例PNS患儿和100例健康儿童BUN和Cr,根据Schwartz公式推算GFR,并以此对肾功能进行分期.结果 肾病组BUN和Cr明显高于对照组,而GFR却显著降低;以GFR为分期标准,在203例PNS患儿中,肾功能1期占72.41%,2期占11.33%,3期占9.85%,4期占4.43%,5期占1.97%;GFR、BUN和Cr对PNS患儿肾功能异常的检出率差异有统计学意义,其中GFR最高.结论 PNS患儿存在不同程度的肾功能损害;Schwartz公式推算GFR可以作为临床评价PNS患儿肾功能改变的敏感指标.     

血清胱抑素C检测对新生儿肾功能评估的临床研究

近年来临床研究和试验表明,血清胱抑素C(Cystatin-C,Cys-C)与传统的血肌酐及尿素测定相比是更好的是检测肾小球滤过率(GFR)的标志物.本研究检测200例危重新生儿及109例非危重住院新生儿血清尿素、肌酐及Cys-C及尿微量蛋白,并对检测结果进行对比分析,探讨Cys-C及尿微量蛋白在评估新生儿肾功能中的临床价值.     

西咪替丁试验纠正肾功能不全患儿肌酐清除率方法及评价

1 使用肌酐清除率评价肾小球滤过率的偏差 肾小球滤过率(GFR)的检测对观察肾脏疾病的进展和预后、药物治疗疗效、透析充分性和移植肾的功能等均有重要意义。目前准确评价GFR的指标是菊粉清除率(Cin)或同位素~(51)铬-乙二胺四乙酸(~(51)Cr-EDTA)等的清除率;临床上用来评价GFR最常用的指标仍然是肌酐清除率(Ccr)。Ccr与实际GFR存在一定的偏差。导致Ccr偏离GFR的     

血清胱抑素C浓度测定对病毒性脑炎患儿肾功能损害的诊断价值

目的：探讨血清胱抑素C(Cyst C)浓度在评估病毒性脑炎患儿肾小球滤过功能中的价值。方法：92例病毒性脑炎患儿为病例组,50例健康儿童为对照组,又根据肾小球滤过率（GFR）将病例组分成肾功能正常组、代偿组、失代偿组和衰竭及终末期组。检测各组血清Cyst C、尿素氮(BUN)、肌酐(Cr)浓度。结果：① 与对照组比较,病例组BUN、Cr及Cyst C均显著增高(P0.05）,在其余各病例亚组间差异有统计学意义（P<0.01）。③Cyst C与BUN、Cr呈显著正相关,与GFR呈显著负相关。结论：病毒性脑炎患儿存在不同程度的肾功能损害;Cyst C是一种比BUN和Cr更好地反映肾小球滤过功能的指标,检测血清Cyst C对病毒性脑炎患儿肾脏功能的监测有重要的临床应用价值。     

Cystatin C对评价肾小球滤过功能的研究

目的：以往常用于临床检测肾小球滤过功能的方法很多,但其准确性受到一定的限制。该研究用Cystatin C对肾小球滤过功能进行评价。方法：用速率散射法测定35例不同肾功能的病人血清Cystatin C,每例患者均测定99mTc-GFR、血清肌酐(Scr)、24 h肌酐清除率(Ccr),以99mTc-GFR作为检测GFR的标准,比较Cystatin C与99mTc-GFR的相关性,及肾功能不全代偿期18例患者Cystatin C与Ccr、 Scr敏感性比较。结果：血清Cystatin C与99mTc-GFR呈显著性负相关,CC=-0.0326×GFR+4.343(r=-0.868),对于肾功能不全代偿期患者Cystatin C与24 h Ccr异常的符合率无统计学差异。结论：Cystatin C与99mTc-GFR有良好的相关性,与24h Ccr有同样的敏感性,比肌酐更能够早期反映肾小球滤过功能的损害,但其具有无放射性,无需昂贵的技术设备,也无需准确留取24 h尿液等优点,适应患者更广泛,作为临床检测肾小球滤过功能更便捷的方法值得推广。     

肾图在儿科临床应用的评价

放射性核素肾图(以下简称肾图)是临床检查肾功能的一项有价值的诊断手段。它的特点是能较系统而全面地反映左右两侧分肾功能,包括肾脏有效血浆流量,肾小管的分泌功能,肾小球滤过率,尿流量以     

肾脏内分泌功能的检查和评价

肾脏除调节水、电解质平衡,维持内环境稳定外,也是体内重要的内分泌器官。现已证明肾脏可以产生和分泌10余种激素和生物活性物质,如肾素、促红细胞生成素、羟化的维生素D_3、前列腺素、内皮素、激肽释放酶和激肽等,在调节血压、水、电解质、红细胞生成、钙磷代谢、机体免疫及神经内分泌等生理活动中起重要作用。     

几种检测肾小管功能的方法及评价

肾小管的生理功能有三方面:物质的重吸收和排泌功能,如钠、钾、氯、钙等电解质,蛋白质、氨基酸、葡萄糖的吸收和排泌;尿液的浓缩稀释;泌氢和尿液酸化。有关这些功能的检测方法不少,现将有关检查作一介绍。     

Pediatric fibromyalgia and dizziness: evaluation of vestibular function.

Twelve children with fibromyalgia and complaints of chronic dizziness were evaluated with both clinical office maneuvers of vestibular function and laboratory tests composed of electronystagmography and sinusoidal harmonic acceleration rotary chair testing. All test results were normal for spontaneous nystagmus with or without visual fixation, oculocephalic reflex, dynamic visual acuity, head-shaking nystagmus, Quix test, and Dix-Hallpike maneuver. Electronystagmography test results were essentially normal for saccades, gaze, Dix-Hallpike, pendular tracking, and caloric evaluation. Rotary chair testing was normal in all 12 patients. These findings suggest that central (brainstem) and peripheral vestibular (inner ear) mechanisms do not account for the complaints of dizziness in the pediatric patient with fibromyalgia. The common musculoskeletal abnormalities of fibromyalgia may affect their proprioceptive orientation, therefore giving them a sense of imbalance.     

早产儿血流动力学及心功能评估的研究进展

早产儿心功能不全是新生儿重症监护室中常见的急危重症,伴随着较高的病死率,可引起严重的近期和远期后遗症。因此了解早产儿血流动力学的主要特点,并准确应用相应的临床监测方法进行早期心功能的评估至关重要。该文将对早产儿血流动力学的主要问题及心功能评估方法作一综述。     

Cardiac function in healthy infants and children: Doppler echocardiographic evaluation

Summary To establish normal values for Doppler-derived parameters of cardiac function, pulsed-wave Doppler recordings from the ascending aorta were obtained in 80 healthy infants and children. Stroke and minute distance, peak velocity, mean acceleration, acceleration and ejection time intervals, and the acceleration/ejection time ratios were measured or calculated from the Doppler recordings. The relations between the Doppler parameters and heart rate, age, and body surface area were analyzed separately for the children below and above 6 months of age. The normal values for the two groups are given as the median and range and as the mean and standard deviations, respectively. For the older age group, strong negative correlations with heart rate were found for stroke distance and ejection time, suggesting that these parameters should be evaluated in relation to heart rate. Intraobserver and interobserver reproducibility were studied in 10 children. Good reproducibility was found for stroke and minute distance, peak velocity, and left ventricular ejection time. For measurements related to acceleration, the reproducibility was less good.     

Noninvasive evaluation of endothelial function and arterial mechanics in overweight adolescents

OBJECTIVE: To evaluate endothelial function and arterial mechanics in apparently healthy overweight adolescents. Design: Analytical observational study. SETTING: Tertiary hospital. METHODS: 40 asymptomatic, normotensive and non-smoking adolescents (11 to 18 years old) were evaluated. Of these 20 were overweight or obese as per International Obesity Task Force criteria while 20 were controls. High resolution ultrasonography was performed to measure flow mediated and Glyceryltrinitrate induced dilation in brachial artery, and arterial mechanics in common carotid artery. RESULTS: Overweight adolescents had significantly lower ratio of flow mediated dilation to Glyceryltrinitrate mediated dilation (0.40 plusminus 0.41 versus 0.61 plusminus 0.17; P = 0.039). On age and sex adjusted multiple regression analysis, the ratio of flow mediated to Glyceryltrinitrate mediated dilation had a significant negative association with body mass index (P = 0.012) and mean skin fold thickness (P = 0.011). However, for mean skin fold thickness, flow mediated dilation also had a significant negative association (P = 0.027). None of the measures of arterial mechanics were significantly different amongst overweights and controls, or significantly associated with either body mass index or mean skin fold thickness. CONCLUSION: Endothelial function can be mildly impaired in apparently healthy adolescents who are overweight (assessed by body mass index) or adipose (assessed by skin fold thickness). The use of overweight for screening adolescents likely to develop coronary artery disease is therefore justified. Skin fold thickness is a better indicator than Body Mass Index for predicting endothelial function.