中药浴治疗慢性肾功能衰竭

目的 :探讨中药浴治疗慢性肾功能衰竭的疗效及其机理。方法 :治疗组 3 2例采用中药肾浴汤治疗 ,对照组 3 0例采用水浴治疗进行对比观察。结果 :治疗组显效 15例 ,有效 13例 ,无效 4例 ,总有效率87.5 0 % ;对照组显效 5例 ,有效 15例 ,无效 10例 ,总有效率 66.67%。经统计学处理两组间差异显著 (P <0 .0 5 )。两组患者经治疗后 ,肾功能、尿蛋白、血红蛋白、血浆白蛋白及血液流变学指标均有显著改善。治疗组在改善肾功能、升高血红蛋白及血浆白蛋白 ,降低血浆纤维蛋白原等方面明显优于对照组。结论 :中药浴治疗慢性肾功能衰竭具有内服药物及其他疗法不可比拟的优越性 ,具有广阔的前景。     

益肾降浊汤治疗慢性肾功能衰竭失代偿期的疗效

目的 观察益肾降浊汤治疗慢性肾功能衰竭失代偿期的临床效果。方法 选择2018年3月~2019年3月在我院治疗的慢性肾功能衰竭失代偿期患者64例,采用随机数字表法分为观察组和对照组,各32例。对照组采用常规西医治疗,观察组在对照组治疗基础上联合益肾降浊汤治疗,比较两组临床治疗总有效率、治疗前后血肌酐（Scr）、尿素氮（BUN）、血清胱抑素C（Cys-C）、尿24h肌酐清除率（24h Ccr）及并发症发生率。结果 观察组治疗总有效率为81.25%,高于对照组的71.87%,差异有统计学意义（P＜0.05）;治疗后两组Scr、BUN、Cys-C水平均较治疗前降低,且观察组低于对照组,差异有统计学意义（P＜0.05）;治疗后两组24h Ccr均较治疗前升高,且观察组高于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率为6.25%,低于对照组的15.62%,差异有统计学意义（P＜0.05）。结论 益肾降浊汤联合常规西药治疗慢性肾功能衰竭失代偿期疗效确切,可改善肾功能,降低并发症发生率,进一步延缓肾功能恶化。     

Effects of Sodium Citrate on Salt Sensitivity and Kidney Injury in Chronic Renal Failure

Metabolic acidosis, which is observed in salt-sensitive hypertension, is also associated with kidney injury. Alkali therapy in chronic renal failure (CRF) may ameliorate the progression of kidney disease; however, few studies have examined the effects of alkali therapy on salt sensitivity and kidney injury in CRF. We randomly administered standard diet (SD), sodium chloride with 20% casein diet (NACL), or sodium citrate with 20% casein diet (NACT) to Sprague-Dawley rats after a CRF or a sham operation. Four weeks after 5/6 nephrectomy, serum bicarbonate levels were higher in the NACT-treated group. On the pressure-natriuresis curve, NACT-treated CRF rats were more salt-resistant than NACL-treated CRF rats. Additionally, the NACT-treated CRF group showed less tubulointerstitial damage than the NACL-treated CRF group. The expression and immunoreactivity of NHE3 in the kidney in the NACT-treated CRF group were lower than those in the NACL-treated CRF group. We observed that dietary NACT as alkali therapy in CRF might improve the altered salt-sensitivity and ameliorate the progression of kidney injury compared to the NACL diet, which may be related to reduced renal NHE3 expression.

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慢性肾功能衰竭患者血液透析和肾移植前后凝血-血栓形成指标的变化

目的:观察慢性肾功能衰竭(CRF)患者血液透析(血透)和肾移植前后凝血-体外血栓形成指标的变化。方法:CRF病人53例,46例采用血透治疗,7例采用同种异体肾移植。分别于治疗前、血液透析10次后、肾移植18个月后检查血浆内皮素-1(ET-1)、抗凝血酶-Ⅲ(AT-Ⅲ)水平以及体外血栓形成的长度和重量。结果:CRF患者ET-1增加,AT-Ⅲ降低,体外血栓较长、较重,与健康对照组比较P均<0.01;血透治疗后ET-1有所降低,AT-Ⅲ有所增加,但体外血栓长度和重量无显著变化(P>0.05);肾移植治疗后血浆ET-1、AT-Ⅲ以及血栓长度和重量均较治疗前有非常显著性统计学差异,P均<0.01,接近健康对照组水平。结论:ET-1和AT-Ⅲ异常变化可促进CRF患者凝血功能增强和血栓形成,肾移植能改善凝血功能,防治血栓形成。     

慢性肾功能不全患者CYFRA21-1水平与肾功能指标的相关性分析

目的 分析慢性肾功能不全患者血清中CYFRA21-1水平与肾功能有关指标的相关性,探讨CYFRA21-1在慢性肾功能不全患者血清中的表达及临床意义.方法 选取在我院进行健康体检者50人作为健康对照组;选取在我院肾脏内科住院的慢性肾功能不全患者50人作为慢性肾功能不全组,本组中再根据是否进行透析分为透析组(29人)和未透析组(21人),每组均抽血检测血清中CYFRA21-1、Cys-C和肌酐的浓度,并进行相关性分析.结果 慢性肾功能不全患者CYFRA21-1、Cys-C、肌酐水平均明显高于健康对照组(P＜0.01);透析组与未透析组之间CYFRA21-1和Cys-C水平无显著差异(P＞0.1);透析组CYFRA21-1与Cys-C水平呈正相关(r=0.61,P＜0.05),与肌酐水平无相关性;未透析组CYFRA21-1与Cys-C(r=0.63,P＜0.05)和肌酐(r=0.59,P＜0.05)水平呈正相关.结论 慢性肾功能不全患者CYFRA21-1水平较正常人明显升高,且与Cys-C水平有一定相关性,可能与肾小球滤过功能减退和肾脏的代谢异常有关.     

长期血液透析对慢性肾衰竭患者肾性贫血、营养状态及炎症因子水平的影响

目的分析长期血液透析对慢性肾衰竭(CRF)患者肾性贫血、营养状态及炎症因子水平的影响。方法选取2016年4月至2018年4月我院行血液透析治疗的CRF患者95例,依据血液透析治疗时间将其分为观察组(透析时间>4个月,n=55)、对照组(透析时间在2~4个月,n=40),比较两组透析前、透析结束时肾功能[β2微球蛋白(β2-MG)、尿素(UA)、血肌酐(Cr)、肾损伤分子1(KIM-1)]、肾性贫血相关指标[铁调素、铁蛋白(SF)、促红细胞生成素(EPO)、血红蛋白(Hb)]、营养状态[总蛋白(TP)、白蛋白(Alb)、钙磷含量]、炎症因子水平[白介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)]。结果两组透析后血清β2-MG、UA、Cr及尿液中KIM-1水平均下降,观察组透析后各指标下降幅度小于对照组(P<0.05);透析后两组肾性贫血、营养状态指标基本改善,但观察组透析后铁调素、EPO、Alb不升反降,且观察组铁调素、SF、EPO、Hb、TP、Alb、钙含量均低于对照组,而磷含量高于对照组(P<0.05);透析后观察组血清IL-6、hs-CRP、TNF-α水平均高于对照组(P<0.05)。结论血液透析可较好改善CRF患者肾功能,纠正其肾性贫血、营养不良状态,降低炎症因子水平,但长期透析治疗可能加重肾性贫血及不良营养状态,应规范透析治疗方案,在透析期间加以监测。     

Chinese Herbal Medicine: A Safe Alternative Therapy for Urinary Tract infection in Patients with Renal Insufficiency

We have used reduced doses of Chinese herbs for estimation of urinary tract infections (UTIs) patients with stable impairment of renal function. A total of 33 adult female patients with moderately impaired renal function and symptomatic UTIs were included in this study. Urine cultures were carried out. Patients were monitored clinically and with various laboratory tests. Chinese herbal concoction divided by milligrams of creatinine per 100 ml were orally administrated for ten days. Three patients were excluded from final analysis. Most of the patients responded symptomatically to treatment. Chinese herbs eradicated the primary pathogen in 68.7% of the patients at the day 10 of treatment. Two patients relapsed (one had abbreviated courses of therapy) 6 to 8 days posttreatment. Organisms which recurred included Escherichia coli and Pseudomonas aeruginosa. Bacterial reinfections occurred 5 to 8 days posttreatment in four patients. Adverse reactions observed among the 30 patients were rare. Nausea (6.67%) and mild elevation of hepatic enzymes (3.33%) were probably drug related. Nausea disappeared when the therapy ended. Elevated hepatic enzymes resumed at the 2-week follow-up. Two patients demonstrated slight increases in serum creatinine on day 10 of treatment. One patient had a 12.5% elevation over baseline and the other had a 13.0% elevation. Serum creatinine values had improved in these two patients at 4-week follow-up. Chinese herbal medicine was effective and safe in the treatment of UTIs with renal insufficiency.