Predictive value of renin determinations in renal artery stenosis

The prognostic value of renal vein and peripheral renin levels was analyzed in 66 patients with unilateral renal artery stenosis who underwent corrective surgery. Patient selection for operation was independent of renin results. Fifty-three percent of those with confirmed renovascular hypertension had renal vein renin ratios less than 2.0, ie, within the 95% confidence limit for the control group of 82 patients with essential hypertension. Thirty-four patients with clearly lateralizing renin data (ipsilateral:contralateral greater than or equal to 1.5 and contralateral:peripheral less than or equal to 1.3) were benefited by operation, but 23 additional patients with nonlateralizing data also benefited. No proposed scheme for renin data analysis detected more than 75% of those with renovascular hypertension. Although lateralizing renin data are highly predictive of operative benefit, nonlateralizing data do not necessarily herald operative failure and should not be dogmatically used to exclude surgical intervention.     

Plasma Renin in ipsilateral renal vein in patients with chronic unilateral pelvic ureteric junction obstruction

Acute experimental hydronephrosis induces increased output of renin from ipsilateral kidney. In most clinical presentation of unilateral hydronephrosis the patients are however, normotensive with normal circulating plasma renin activity. In consideration of this argument we undertook this prospective study of ipsilateral renal vein renin activity in children with congenital Pelvic Ureteric Junction Obstruction (PUJO) and compared with other wise normal children. In this prospective cross-sectional study, started from July 99 to June 2001, twenty patients, age upto 12 years, with unilateral hydronephrosis and in control group ten patients without hydronephrosis were taken. 2ml blood was taken from the renal vein in study group and from infrarenal portion of inferior vena cava during exploratory laparotomy from the control group. All the patients had advanced grade of hydronephrosis and two patients (13%) had mild hypertension. In this study the mean plasma renin activity (PRA) was 45.58 ng/ml/hr (range: 11.69-67.56 ng/ml/hr) in study group. The mean PRA in control group was 5.9ng/ml/hr. The result of study group was significantly higher than normal (P value 0.0003). In Bangladesh we are doing more conservative kidney preserving surgery for PUJO, but need long term follow up of the patients undergoing surgery for PUJO in childhood for potential of developing renin-angiotensin induced hypertension in later life.     

Differential Renal Function Studies in the Diagnosis of Renal Hypertension

Over a 10-year period, positive criteria of the Howard test and the Rapoport Index have shown consistently good correlation with sustained relief or marked improvement in hypertension, in patients with main renal artery lesions. Similar correlation was obtained with ischemic criteria from histopathologic studies.

Differential function studies did not reveal positive ischemic criteria in any patient operated upon for unilateral parenchymal disease. Histopathologic criteria of ischemia were also infrequent in this group. Nevertheless, marked improvement or cure of hypertension occurred in 62% of the latter. No factor can be used to predict improvement in this type of renal hypertension. Differential renal function criteria may occasionally appear to indicate renal artery ischemia in the more normal kidney in patients with unilateral parenchymal renal disease; wrong interpretation is avoided by taking differential creatinine clearance into account. Until vasopressor substances can be easily measured and accurately interpreted, aortography is indicated in selected patients.

     

Synchronous nephrectomy with unilateral dual kidney transplantation: feasibility in patients with adult polycystic kidney disease

Adult polycystic kidney disease (APKD) accounts for 2% of end-stage renal disease in Singapore and is a major indication for kidney transplantation. We report synchronous nephrectomy with unilateral cadaveric dual kidney transplantation (DKT) in a patient with APKD. Simple nephrectomy of the right native 27-cm polycystic kidney was performed to provide adequate space for unilateral DKT. Right donor kidney transplantation was performed at the site of native nephrectomy. End-to-side anastomosis of the right donor renal vein to the distal inferior vena cava and the right donor artery to the common iliac artery were performed. Left donor kidney was transplanted below the right kidney, with its vessels anastomosed to the right external iliac vessels. Ureter anastomosis was performed after perfusion of both kidneys. Lich-Gregoir anastomosis of the left donor ureter to the bladder and direct right donor ureter to native ureter anastomosis was established. This case illustrates that synchronous nephrectomy with DKT is feasible to facilitate implantation on the same side.     

大鼠阿霉素肾病超微结构转变过程实验研究

目的探讨单侧肾切除加重复注射阿霉素制作的大鼠局灶节段性肾小球硬化动物模型肾脏超微结构的变化过程,为采用阿霉素肾病模型提供实验基础。方法2个月龄雌性SD大鼠38只,随机分为对照组(18只)和阿霉素肾病组(ADR组,20只)。ADR组大鼠先行右肾切除,其后第1周和第2周分别给予阿霉素5mg/kg和3mg/kg尾静脉注射,对照组行假手术和等量生理盐水静脉注射。在切肾后第4、8、16周收集血标本测定血肌酐(Scr)和尿液测定24h尿蛋白定量,各时间点处死6只大鼠取其残肾行光镜组织病理学观察及电镜超微结构观察。结果ADR组Scr和尿蛋白在各时间点均较对照组显著升高(P<0.05);ADR组大鼠肾脏组织病理损害进行性发展,在第16周时形成FSGS改变;电镜下早期以肾小球足细胞广泛融合为主,在第8周时有少部分修复,16周时出现肾小球硬化;肾小管上皮细胞主要表现为大量线粒体肿胀和空泡变损伤。结论单侧肾切除加重复注射阿霉素可成功诱导局灶节段性肾小球硬化大鼠动物模型,其超微结构变化包括肾小球和肾小管双重损伤,若干预需早期进行。     

临床分期为cT1a肾肿瘤术后出现慢性肾脏病的危险因素分析

目的分析和探讨临床分期为cT1a的肾肿瘤患者术后出现慢性肾脏病（chronic kidney disease,CKD）的危险因素。方法统计和分析2004年10月～2011年10月期间212例术前临床分期为cT1a的。肾肿瘤患者,分为根治性肾切除术（radical nephrectomy,RN）组（n=115）和肾脏肿瘤部分切除术（partial nephrectomy,PN）组（n=97）．观察两组术后肾功能的变化。用MDRD法来估计。肾小球率过滤。其中CKD定义为。肾小球率过滤〈60mL／（min·1．73㎡）,持续3个月及以上。结果RN组共115例患者,PN组共97例患者。术后平均随访32．2（1．5～84）个月,共有80例（37．7％）患者出现了CKD,其中RN组69例（60％）,PN组11例（11.3％）。RN组5年未出现CKD的无疾病生存率（disease—free survival,DFS）为22．1％,PN组DFS为52．4％,差异有统计学意义（P〈0．01）。糖尿病患者共22例．其中14例（63．6％）术后出现CKD,行RN术12例,行PN术2例。糖尿病组5年DFS为14．3％,高于无糖尿病组（37．8％）,差异有统计学意义（P〈0．01）。Cox多因素分析提示年龄,糖尿病,手术方式,术前肾小球滤过率,高血压为肾肿瘤患者术后出现CKD的独立因素。结论对于临床分期为cT1a期的,尤其是高龄或伴有糖尿病的肾肿瘤患者,应尽可能行保留肾单位手术以降低术后出现CKD的风险。     

单侧肾切除 微渗透泵灌注灌注血管经张素II诱导小鼠肾纤维化模型

【摘要】目的 建立单侧肾切除及微渗透泵灌注血管紧张素II诱导小鼠肾纤维化模型。方法 将36只雄性野生型 c57BL/6小鼠随机分为3组正常组、模型组、生理盐水对照组,每组12只。正常组不做处理,模型组行单侧肾切除及微渗透泵灌注血管紧张素II,生理盐水对照组行单侧肾切除及微渗泵灌注生理盐水。观察造模前及造模后第2周、第4周小鼠血压及肾脏病理变化。结果 实验第二周时,生理盐水对照组（P＜0.05）及模型组（P＜0.01）的血压较正常组升高,模型组较生理盐水对照组也升高（P＜0.05）;实验第四周时,模型组血压较正常组（P＜0.01）及生理盐水对照组（P＜0.05）均升高。模型组HE染色结果近曲小管上皮细胞浑浊肿胀;模型组Masson染色结果胶原纤维阳性率显著高于正常组和生理盐水对照组（P＜0.05）。结论 单侧肾切除+微渗透泵灌注血管紧张素II可以成功建立小鼠肾纤维化模型及高血压模型。     

血浆肾素活性和血管紧张素Ⅱ在肾血管性高血压病人中的临床应用

本文对26例肾血管性高血压(RVH)病人外周血,双侧肾静脉血及下腔静脉血中血浆肾素活性(PRA)及血管紧张素Ⅱ(AT Ⅱ)的测定结果及其有关因素进行了分析,得出如下结论:(1)本组单侧RVH病人肾静脉肾素活性比值(RVRR)的阳性率为53.8％;ATⅡ比值阳性率为45.5％。(2)本组单侧RVH病人的近期手术疗效在达到和未达到阳性标准的病人间无明显差异。(3)RVH肾静脉血中的PRA和ATⅡ有高、正常和降低三种类型。(4)肾实质受损,PGE和激素缺乏是某些正常和低肾素型RVH的可能病因。(5)RAAS,KKS和PGS多指标的测定和观察可能有助于阐明正常和低肾素型RVH的发病机理,并有助于提高诊断符合率和选择手术病人的阳性率。     

Renal vein plasma adenosine 3'',5''-cyclic monophosphate in renovascular hypertension.

The concentration of plasma adenosine 3',5'-cyclic monophosphate (cyclic AMP) and plasma renin activity (PRA) were measured concomitantly in blood from both renal veins and in arterial blood in 22 hypertensive patients. In the nine patients with true renovascular hypertension the concentration of plasma cyclic AMP was greater in the venous effluent of the kidney affected by the renal artery stenosis than in that of the unaffected or less affected kidney. The arteriovenous difference in cyclic AMP concentration was less on the affected side in all but one patient. The arteriovenous differences in PRA identified the affected kidney as the source of hyper-reninemia and showed that renin release from the other kidney was suppressed. In the 13 patients with hypertension associated with but unrelated to renal artery stenosis there were no consistent patterns of cyclic AMP concentration or PRA in the venous effluent of the kidneys or of their arteriovenous differences. In renovascular hypertension the venous effluent of the kidney affected by renal artery stenosis contains not only more renin but also more cyclic AMP, owing to either increased cyclic AMP production or decreased excretion or extraction of cyclic AMP by the affected kidney. This unilateral increase in cyclic AMP concentration may become a complementary diagnostic feature of true renovascular hypertension.     

肾静脉肾素水平与肾动脉介入治疗疗效的相关性研究

目的探讨肾静脉肾素活性,血浆内皮素(ET)、一氧化氮(NO)、钙素基因相关肽(CGRP)水平对肾动脉狭窄介入治疗疗效的预测价值。方法60例冠心病合并高血压患者经肾动脉造影,证实为肾动脉狭窄,予肾动脉支架植入术;测定所有病例介入治疗前后的肾静脉肾素活性和血浆ET、NO、CGRP水平。并对病人的血压进行2年随访。结果60例患者根据术前肾素水平分为肾素比值(RVRR)>1.5组和RVRR<1.5组。所有患者肾动脉狭窄侧肾静脉肾素活性高于对侧[(3.89±3.14)nmol/L/h和(2.01±1.93)nmol/L/h,P<0.05],介入治疗后患侧肾静脉肾素浓度明显下降,RVRR>1.5组低于RVRR<1.5组[(1.92±2.15)nmol/L/h和(2.42±0.56)nmol/L/h,P<0.05],血浆ET和NO水平与RVRR<1.5组相比有统计学差异(P<0.05),术后血压明显下降,血压有效率75.68%,与RVRR<1.5组比P<0.05。结论测定肾静脉肾素活性,血浆ET、NO的水平对肾动脉血管成形术近期疗效有预测价值。     

健康大鼠单侧肾切除后肾脏的代偿功能观察

目的观察正常大鼠摘肾后生理变化和代偿侧肾脏的病理变化，为肾移植的进一步推进与发展提供理论依据。方法采用尿肌酐检测试剂盒检测尿肌酐；考马斯亮蓝法检测尿蛋白；自动生化仪检测肾功能；PAS特殊染色方法观察肾脏病理变化。结果2～3月龄、7～9月龄和10～12月龄的肾切组大鼠的尿蛋白，肌酐比值于术后1个月显著升高（P〈0．001），其中2～3月龄和7-9月龄雄性肾切组的术后2个月降至正常，雌性肾切组的术后3个月降至正常，而10～12月龄的均在术后3个月降至正常；4～6月龄肾切组的与正常组的比较无明显差异（P〉0．05）。结论单侧肾切除术后1～2个月为关键期，直接关系到大鼠术后的近期和远期的安全性；年龄幼小或老年者单侧肾切除后肾脏损伤的风险大：雄性大鼠代偿功能较好。     

保留肾单位手术治疗早期小肾癌21例临床分析

OBJECTIVE: To evaluate the clinical effects of nephron-sparing surgery in patients with early-stage small renal cell carcinoma. METHODS: Nephron-sparing surgery was performed in 21 patients with renal cell carcinoma including 1 with solitary kidney, 3 with unilateral tumor and contralateral renal compromise, and 17 with unilateral tumor and normal contralateral kidney. The diameter of the tumors ranged from 1.5 to 6.0 cm, with a mean of 2.8 cm. The tumor diameter in 17 patients with normal contralateral kidney was less than 4 cm (mean 2.5 cm) and the average diameter in 4 patients with contralateral renal compromise was 4.2 cm. Sixteen cases were in stage T(1), 4 in stage T(2), and 1 in stage T(3). Of the 21 patients, 4 underwent tumor enucleation, 10 polar nephrectomy and 7 wedge resection. RESULTS: All patients were followed up for an average of 40.8 months (7 to 66 months). One patient suffered a right lung and mediastinum metastasis 3 years after the surgery later and 1 with chronic glomerulonephritis required dialysis 27 months after the operation. No surgical complication or local recurrence were found in other patients. CONCLUSION: As a safe and effective therapy for early-stage small renal cell carcinoma, nephron-sparing surgery can be considered as the gold-standard therapy for patients with lesions less than 4 cm in T(1) and T(2) stages of localized unilateral tumor with normal contralateral kidney.     

慢性肾脏病患者外周血 FGF-23水平与钙磷代谢的相关性分析

目的：研究慢性肾脏病（CKD）患者外周血 FGF-23水平与钙磷代谢的相关性。方法：对2014年2月～2015年3月于我院接受治疗的68例 CKD 患者以及20健康人士进行空腹抽取静脉血,并采用 ELISA 法检测FGF-23、全自动生化分析仪检测血清中血钙、血磷及碱性磷酸酶（ALP）的含量。结果：CKD 患者外周血 FGF-23水平与血清中血钙呈现负相关,与血磷及碱性磷酸酶（ALP）呈现正相关。结论：慢性肾脏病患者外周血 FGF-23水平与钙磷代谢有一定的相关性。     

高血压病治疗前后细胞内离子变化的研究

本文报道50例原发性高血压与23例正常对照的白细胞K、Na、Ca含量测定结果及巯甲丙脯酸、硝苯吡啶、双塞降压治疗对白细胞K、Na、Ca含量和外周阻力的影响。发现高血压组Na、Ca含量明显高于正常对照（p＜0.005与p＜0.02）三种药物治疗后，白细胞Na含量均明显下降（p＜0.05或p＜0.01）。仅硝苯吡啶和双塞治疗后白细胞Ca含量及外周阻力的下降有显著意义。但白细胞Na、Ca含量的下降程度与血压和外周阻力的下降幅度间无直线相关。     

肾移植术后慢性排斥患者外周血Th17细胞的表达

【目的】探讨外周血Th17细胞及相关细胞因子与肾移植术后慢性排斥反应发生的关系。【方法】自2007年1月至2010年8月,在中山大学附属第一医院和第三医院收集尿毒症（尿毒症组）、肾移植术后6个月内未发生慢性排斥反应（非慢排组）及6个月内发生慢性排斥反应（慢排组）患者的外周血共75例,其中每组各25例。采用流式细胞术（FCM）检测外周血中CD4+T细胞中Thl7细胞的频率。采用酶联免疫吸附法(ELISA)检测血清中Th17细胞相关细胞因子白介素-17 (IL-17)、白介素-22 (IL-22)和白介素-23 (IL-23)的水平。分析比较组间差异。【结果】术后慢排组Thl7细胞的频率为（3.82±1.7）%,明显低于非慢排组（22.0±11.0）%和尿毒症组（17.2±8.0）%,差异均有统计学意义（P < 0.01）。肾移植术后慢排组患者产生IL-17的量为（7.8±1.3）pg/mL,明显低于非慢排组（17.0±6.0）pg/mL（P < 0.05）和尿毒症组患者（20.4±9.0）pg/mL（P < 0.01）,差异均有统计学意义。IL-22和IL-23在三组间差异无统计学意义（P > 0.05）。【结论】外周血中Th17细胞可能通过分泌细胞因子IL-17参与了肾移植术后慢性排斥反应的发生。     

10140例肾结石患者临床合并症及相关因素分析

目的 评估肾结石患者的人口学分布和临床合并症特点并探索其相关因素,为临床防治提供依据。方法 回顾性分析2017年1月至2020年12月海军军医大学附属长海医院门诊及住院患者中影像学报告为肾结石的10140例患者。根据受累肾脏情况,分为单侧肾结石组(单侧组)及双侧肾结石组(双侧组),分析两组人群在年龄、性别、实验室检查、常见临床合并症上的差异,采用logistic回归探寻可能影响双侧肾结石形成的相关因素。结果 10140例肾结石患者的平均年龄为57.75±13.30岁,男女比例为2.25:1。其中单侧组8171例（80.6%）,双侧组1969例（19.6%）。所有肾结石患者最常见的临床合并症依次为高血压病(HT)、肿瘤、高尿酸血症、糖尿病(DM)、冠心病(CHD)、脑血管疾病。两组在年龄、性别的分布,以及HT、肿瘤、高尿酸血症、CHD的合并率方面差异有统计学意义(P<0.05);而在体重指数(BMI)、DM、脑血管疾病的合并率方面差异无统计学意义(P>0.05)。实验室检查方面,单侧组血清肌酐(Cr)、尿酸(UA)、尿pH值水平低于双侧组(P<0.05);而高密度脂蛋白胆固醇(HDL-C)水平高于双侧组(P<0.05);空腹血糖(FPG)、甘油三酯(TG)、胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平方面两组之间差异无统计学意义(P>0.05)。此外,性别(男性)、高尿酸血症可能是双侧肾结石形成的重要相关因素(P<0.05),而合并肿瘤则更倾向于表现为单侧肾结石患者(P<0.05)。结论 肾结石更多见于中年男性,代谢综合征相关疾病在肾结石的发展过程扮演了重要角色,有必要加强这些疾患的早期防治。肾结石患者肿瘤合并率高,提示两者存在关联。此外,较单侧肾结石而言,男性、合并高尿酸血症与双侧肾结石形成关系更密切,应当引起重视。     

保留肾单位的肾癌手术(附11例报告)

目的：探讨保留肾单位的肾癌手术治疗方法和疗效。方法：对1993年2月-2003年2月共11例经手术和病理证实为肾细胞癌的临床资料进行回顾性分析，其中双侧肾癌3例，孤立肾癌5例，对侧肾有病变或潜在功能受损的肾癌2例，对侧肾正常肾癌1例；11例中6例行肿瘤剜除术，5例行肾部分切除术。结果：本组术后无外科并发症，平均随访40个月，无局部复发和肿瘤转移。结论：对经选择的患者保留肾单位的肾癌手术安全可靠，疗效满意。     

单侧肾切除及微渗透泵灌注血管紧张素II诱导小鼠肾纤维化与高血压模型的建立

目的 建立单侧肾切除及微渗透泵灌注血管紧张素II诱导小鼠肾纤维化模型。方法 将36只雄性野生型 c57BL/6小鼠随机分为3组正常组、模型组、生理盐水对照组,每组12只。正常组不做处理,模型组行单侧肾切除及微渗透泵灌注血管紧张素II,生理盐水对照组行单侧肾切除及微渗泵灌注生理盐水。观察造模前及造模后第2周、第4周小鼠血压,及造模4周后的24 h尿蛋白定量、血肌酐、尿素氮、肾脏病理。结果 实验第二周时,生理盐水对照组(P<0.05)及模型组(P<0.01)的血压较正常组升高,模型组较生理盐水对照组也升高(P<0.05);实验第四周时,模型组血压较正常组(P<0.01)及生理盐水对照组(P<0.05)均升高。模型组的血肌酐、血尿素氮数值较正常组均上升(P<0.05);模型组24 h尿蛋白定量数值较正常组与生理盐水对照组的升高(P<0.01),模型组HE染色结果近曲小管上皮细胞浑浊肿胀;模型组Masson染色结果胶原纤维阳性率显著高于正常组和生理盐水对照组(P<0.05)。结论 单侧肾切除+微渗透泵灌注血管紧张素II可以成功建立小鼠肾纤维化模型及高血压模型。     

保留肾单位手术治疗早期小肾癌21例临床分析

目的 探讨保留肾单位手术治疗早期小肾癌的临床效果。方法 1999年4月~2004年3月,行保留肾单位手术治疗小肾癌21例,其中孤立肾1例,对侧肾有病变或肾功能受损3例,对侧肾正常17例。肿瘤直径1.5~6.0 cm,平均直径2.8cm;其中对侧肾正常者直径均<4cm,平均2.5cm;对侧肾有病变或受损者平均直径为4.2cm。TNM分期:T₁期16 例,T₂期4 例,T₃期1例。4例行肿瘤剜除术,10例行肾极切除术,7例行肿瘤楔形切除术。结果 21例随访7~66个月,平均随访40.8个月。1例3年后发现右肺及纵隔转移,1例术后27月因慢性肾小球肾炎接受透析治疗。其余19例未见并发症及肿瘤局部复发。结论 保留肾单位手术是早期局限性肾癌的安全有效治疗方法,可作为治疗对侧肾正常直径<4cmT₁~T₂期局限性肾癌的金标准。     

Nephron-sparing surgery for small renal cell carcinoma

Objective:To investigate the method and effect of nephron-sparing surgery in the treatment of small renal cell carcinoma. Methods: From August 1997 to October 2008, 48 cases of small renal cell carcinomas were confirmed by surgery and pathology, and reviewed retrospectively. Of the 48 cases, there was 1 patient with bilateral tumors, 8 with solitary kidney tumors, 1 with unilateral tumor and a damaged contralateral kidney, and 38 with unilateral tumors and a normal contralateral kidney; 9 underwent tumor enucleation and the remaining patients received partial nephrectomy. Results:There were no local tumor recurrences and/or tumor metastasis at a mean follow--up of 60 months. Conclusion: Confirming conclusions from other centers, we have found that nephron-sparing surgery is an effective treatment for small renal cell carcinomas.