肾移植术后并发急性肾小管坏死的观察与护理

目的探讨肾移植术后急性肾小管坏死的护理.方法急性肾小管坏死是肾移植术后较严重而常见的并发症.本文对26例同种异体尸体肾移植术后并发急性肾小管坏死的护理体会进行总结.结果全部病例均控制病情,无肾移植失败.结论认为细致的心理护理,严密的病情观察,及时合理的医护措施,是处理该并发症的重要措施.     

肾移植术后并发急性肾小管坏死患者的观察与临床护理

目的:探讨肾移植术后急性肾小管坏死的护理。方法:急性肾小管坏死是肾移植术后早期较严重而常见的并发症,一旦出现很可能预示手术的失败,对护理要求亦较高。本文对21例同种异体尸体肾移植术后并发急性肾小管坏死的护理体会进行总结。结果:全部病例均控制病情,无肾移植失败。结论:认为细致的心理护理,严密的病情观察,及时合理的医护措施,是处理该并发症的重要措施。     

肾移植术后急性肾小管坏死病人的护理

急性肾小管坏死是肾移植术后早期常见的并发症，一旦出现很可能预示手术的失败，对护理要求亦较高，本文报告了7例肾移植术后急性肾小管坏死的护理经验。就如何帮助病人建立健康的心理状态，多尿期和少尿期的护理，以及预防高血压，脑血管意外，感染等术后并发症等问题进行了讨论。     

肾移植术后急性心力衰竭的观察及护理

急性心力衰竭是肾移植术后严重并发症之一。随机抽取我科l996年7月至2001年6月肾移植术后发生急性心力衰竭的病例82例进行分析，发现术前原发姓高血压，术后继发性高血压及排斥反应、急性肾小管坏死等引起的少尿、无尿、水钠潴留可加重患的心脏负荷，易导致急、慢性心力衰竭。认为熟悉心力衰竭的临床表现，及时发现病情变化，科学管理出入量，控制血压，加强生活护理及心理护理，消除患紧张、恐惧心理等，是有效防治肾移植术后急性心力衰竭的必要措施。     

肾移植术后少尿原因分析及护理对策

目的:探讨肾移植术后少尿原因和护理对策。方法:对10例肾移植术后少尿或无尿的患者实施心理护理、病情观察、药物毒副作用的观察及预防感染、饮食指导等护理。结果:2例因急性排斥反应而未恢复肾功能,8例移植肾恢复正常功能。结论:肾移植术后少尿或无尿的原因,为移植肾急性肾小管坏死,加强心理护理及病情观察,及时采取相应的护理措施,可为移植肾恢复正常肾功能提供保证。     

肾移植术后少尿原因分析及护理对策

目的探讨肾移植术后少尿原因和护理对策.方法对10例肾移植术后少尿或无尿的患者实施心理护理、病情观察、药物毒副作用的观察及预防感染、饮食指导等护理.结果2例因急性排斥反应而未恢复肾功能,8例移植肾恢复正常功能.结论肾移植术后少尿或无尿的原因,为移植肾急性肾小管坏死,加强心理护理及病情观察,及时采取相应的护理措施,可为移植肾恢复正常肾功能提供保证.     

肾移植术后早期补液原则及护理

目的 探讨肾移植术后早期（1-7d）补液原则,减少肾移植术后早期因输液引起的并发症。方法 对500例肾移植术后患者早期补液量、速度、种类及出现的相关并发症进行回顾性分析。结果 72例在肾移植术后早期出现补液不足,56例出现补液过多,并伴有相关的临床表现及体征。结论 掌握肾移植术后早期补液原则,是防止急性肾小管坏死、心血管并发症、电解质紊乱的关键;对肾移植术后早期患者水电解质的观察和护理是护理工作的重要内容。     

高龄肾移植患者术后护理体会

近几年来，由于。肾移植外科技术不断娴熟及环孢素等抗排斥药物的应用，高龄。肾移植患者日益渐多。高龄尿毒症患者(50岁以上)的。肾移植手术难度大，术后并发症多，对护理要求亦很高。就如何帮助病人建立健康的心理状态，术前对高血压，慢性心肺疾病的护理以及术后除排异反应外，主要并发症急性肾小管坏死、心衰、脑血管意外、感染等的防治。     

移植肾功能延迟恢复的病因分析和护理

通过对18例同种异体肾移植手术后并发移植肾功能延迟恢复(以下简称DGF)的病因进行分析并对护理体会进行总结。急性肾小管坏死，急性排斥反应，环孢素A肾中毒是导致DGF发生的主要病因。严密的病情观察和合理的治疗措施以及科学的心理护理是处理DGF的重要措施。     

肾移植术后的饮食护理

肾移植术后患者如处在正常恢复期可根据恢复情况由清流质、流质、半流质、普食为序进行饮食护理;如术后出现排异反应,急性肾小管坏死,肾功能下降,要根据病情进行饮食护理,并须强调饮食卫生。     

Doppler ultrasound in the diagnosis of renal allograft rejection and in monitoring the effect of treatment

Thirty-six consecutively transplanted renal allograft patients were prospectively monitored with ultrasound-Doppler examinations three times weekly during the first 3 weeks after transplantation. Although triple-immunosuppressive therapy consisting of cyclosporin A, azathioprine and prednisolone was used, acute rejection occurred in 11 patients. Nine patients had immediate onset of graft function and no rejection. Ten patients had acute tubular necrosis (ATN) without any signs of rejection and were treated with dialysis for 1-3 weeks after transplantation. Thrombosis of the renal artery was diagnosed in four patients. During rejection episodes pulsatility index (PI) was above normal range in all patients. In patients with mild to moderate ATN and PI was normal throughout the clinical course whereas two patients with severe ATN but no signs of rejection in the kidney biopsy also had high PI. It is concluded that serial Doppler velocity examination after kidney transplantation is a non-invasive, cheap and reliable method for monitoring of the graft. The method can be used in the early diagnosis of rejection, and it is of special value in monitoring grafts without function.     

Prospects of antisense oligodeoxynucleotides to alleviate renal ischaemia-reperfusion injury

Renal ischaemia-reperfusion (I/R) injury is a clinically significant problem and an invariable consequence of renal transplantation. The problem begins at the onset of acute tubular necrosis (ATN), when the transplantation takes a long ischaemic interval by using the cardiac arrest donor's kidney. In addition, the longer the ischaemic interval, the higher the incidence rate of ATN. It is clinically important that renal I/R injury is reduced. The antisense oligodeoxynucleotide (AS-ODN), developed as a therapy for intractable diseases at the gene level, has recently been established as an important method in examining specific gene functions. The authors have previously demonstrated that AS-ODN/tissue factor (TF) prevents renal I/R injury. This review discusses the efficacy of AS-ODN/TF and AS-ODN/intercellular adhesion molecule-1 as existing targets, and the potential of AS-ODN/nuclear factor-kappaB, AS-ODN/cyclooxygenase and AS-ODN/5-lipoxygenase as prospective targets.     

Prospects of antisense oligodeoxynucleotides to alleviate renal ischaemia–reperfusion injury

Renal ischaemia–reperfusion (I/R) injury is a clinically significant problem and an invariable consequence of renal transplantation. The problem begins at the onset of acute tubular necrosis (ATN), when the transplantation takes a long ischaemic interval by using the cardiac arrest donor’s kidney. In addition, the longer the ischaemic interval, the higher the incidence rate of ATN. It is clinically important that renal I/R injury is reduced. The antisense oligodeoxynucleotide (AS-ODN), developed as a therapy for intractable diseases at the gene level, has recently been established as an important method in examining specific gene functions. The authors have previously demonstrated that AS-ODN/tissue factor (TF) prevents renal I/R injury. This review discusses the efficacy of AS-ODN/TF and AS-ODN/intercellular adhesion molecule-1 as existing targets, and the potential of AS-ODN/nuclear factor-kappaB, AS-ODN/cyclooxygenase and AS-ODN/5-lipoxygenase as prospective targets.     

彩色双功超声对移植肾急性排异及急性肾小管坏死的实验研究

本研究用山羊建立肾移植模型，分为三组：（1）正常对照组；（2）急性肾小管坏死组（ATN）；（3）急性排异组（AR），每组6只。前两组采用自体肾移植，AR组采用同种异体肾移植。结果表明；①肾移植术后，正常对照组、AR组、ATN组移植肾长度均较术前增加，分别为8．4％、28％、12．5％，以AR纷增大明显（P＜0．05），AR组的厚径、体积、皮质厚径也较正常对照组增大（P＜0．05）；②AR组和ATN级皮质部RI均高于正常对照组（P＜0．01），ATN组RI峰值时间早于AR组；③AR组排异早期，肾皮质动脉峰值流速增快；④彩色多普勒能量图评价肾皮质血流灌注明显优于彩色多普勒血流显像。     

Acute tubular necrosis: diagnosis, treatment, and nursing implications.

Acute tubular necrosis (ATN) is the most common cause of acute renal failure. Early recognition of patients who are at risk for ATN can prevent or improve the course of ATN. Acute renal failure is classified as prerenal, intrinsic, or postrenal disease. ATN is classified as a type of intrinsic renal disease. The clinical course of ATN is divided into the renal failure phase, diuretic phase, and recovery phase, with each phase having distinct symptoms and laboratory findings. Diagnosis of ATN often is complicated and confusing; understanding of laboratory findings can facilitate the critical care nurse's ability to assess those at risk for ATN. The care and treatment of the patient with ATN is complicated, and specific treatments are discussed in detail. The critical care nurse can play a vital role in identifying the patient at risk, preventing the development of ATN in those at risk, and providing appropriate care for those who develop ATN.     

Renal response to shock

When the MAP decreases below approximately 75 mm Hg, renal autoregulatory processes are no longer effective. Decreased renal blood flow often leads to ATN and its related uremic syndrome. The patient with ATN typically experiences four successive phases as the ATN progresses and then eventually resolves. During the oliguricanuric phase of ATN, multiple organ systems and physiologic processes are affected by the alterations occurring as the result of severely altered renal function. With appropriate treatment, such as fluid-electrolyte and acid-base control, nutritional support, and renal replacement therapy, a return to normal renal function is often possible.     

Clara细胞分泌蛋白检测对急性肾小管坏死诊断的意义

目的：探讨Clara细胞分泌蛋白（CCSP）检测在诊断急性肾小管坏死（ATN）中的意义，以提高ATN的早期诊断率。方法：选取4例ATN患者肾活检组织，以原发性慢性肾小球肾炎[膜性肾病（MN）／微小病变（MCD）n=4]患者的肾脏及4例正常肾组织作为对照，应用免疫组化和免疫荧光方法检测肾脏组织的CCSP表达。选择10例ATN、10例原发性慢性肾小球炎（MN／MCD）和15例正常对照，采用ELISA法测定其血、尿CC16浓度。结果：免疫组化和免疫荧光结果显示,ATN组、MN／MCD组及正常对照组，肾小球中均无CCSP表达，肾小管上皮细胞有CCSP表达。而其中ATN患者则因肾小管受损，其肾小管上皮细胞CCSP表达较另2组下降。ATN患者起病期与肾功能恢复期间尿CC16差异有统计学意义[（1624．45±1119．11）ng／mL比（472．60±289．36）ng／mL，P〈0．01]。尿CC16浓度在ATN起病期显著增高，与正常对照组、MN／MCD组间差异有统计学意义（P〈0．05）。结论：检测肾组织中CCSP有助于判断患者的肾小管功能．特别是近端肾小管受损情况：尿CC16浓度测定可作为急性肾小管损伤的指标，且与受检者肾组织中CCSP表达相吻合。     

Investigation of Doppler waveforms in porcine renal allografts: Doppler-pathologic correlation

A porcine model was devised to investigate Doppler waveforms in dysfunctional renal allografts. NIH miniature pigs served as allografts donors and recipients. Renal transplantation was effected into the recipient pelvis while the left normotopic kidney was subjected to warm ischemia in order to induce acute tubular necrosis (ATN). Doppler demonstration of allograft arterial occlusion in six animals was confirmed at surgery. Increased pulsatility of intrarenal arterial signals constituted evidence of vascular rejection in two animals. Biopsies confirmed the diagnosis in both cases. Histologic changes of ATN were identified in two native kidneys subjected to ischemia. No waveform or pulsatility alterations were observed in these animals. The porcine model provides for the investigation of allograft Doppler waveforms in a controlled setting with free access to biopsy and operative pathologic correlation.     

Diagnosis of kidney damage using novel acute kidney injury biomarkers: assessment of kidney function alone is insufficient

Acute kidney injury (AKI) is a syndrome that is associated with a major burden of morbidity and mortality in a variety of high risk patient populations, many of them cared for by intensivists. Following renal transplantation, delayed graft function (DGF) caused by severe acute tubular necrosis (ATN), defined by a requirement for dialysis during the initial post-transplant week, complicates postoperative management, and if prolonged (>14 days), adversely affects allograft survival. Neutrophil gelatinase-associated lipocalin (NGAL) and other novel biomarkers can detect AKI earlier than serum creatinine, and can predict AKI severity in high risk patient populations, including kidney transplant recipients. Hollmen and colleagues now demonstrate that elevated urine NGAL in deceased kidney donors is a significant risk factor for prolonged post-transplant DGF in recipients. These findings have clear implications with regard to potentially improved assessment of deceased donor suitability for potential renal allograft donation. These findings are also consistent with the growing evidence that severe ATN diagnosed by markedly elevated levels of AKI biomarkers is a useful predictor of the requirement for acute renal replacement therapy in AKI patients.     

Do serum C-reactive protein measurements help to discriminate episodes of renal dysfunction in patients after renal transplantation?

INTRODUCTION: This study investigated whether serial daily measurements of serum C-reactive protein (sCRP) could help differentiate episodes of transplant dysfunction due to rejection, infection, cyclosporine A (CsA) nephrotoxicity, or acute tubular necrosis (ATN) in renal-allograft recipients. MATERIALS AND METHODS: Morning serum was obtained daily from 134 patients during the first 30 days after renal transplantation. All episodes of graft dysfunction were recorded and differentiated with transplant biopsies. CRP concentrations were correlated with post-operative graft function and the various causes of graft dysfunction. RESULTS: All patients showed an increase in sCRP in response to surgery, with a maximum on day 2 after transplantation. The sCRP concentration was significantly higher in patients with delayed graft function (mean 61.50 microg/ml) than in patients with primary graft function (mean 38.01 microg/ml) (p=0.001). Bacterial infections other than asymptomatic bacteriuria (mean sCRP 33.98 microg/ml), interstitial graft rejection (mean sCRP 16.43 microg/ml), and ATN (mean sCRP 30.50 microg/ml) were accompanied by significant increases in sCRP compared with uneventful courses. sCRP was unchanged in the presence of viral infections or CsA toxicity. CONCLUSION: Serial sCRP measurements help to identify renal-transplant dysfunction of different origins. However, rejection, infection and ATN show similar patterns of sCRP increase. Thus, sCRP is unable to discriminate the causes of renal-graft dysfunction. Biopsy remains the gold standard for the differential diagnosis of renal-allograft dysfunction.